Details of applicant
Nature of applicant (incorporated or otherwise):
If unincorporated, attach proof of identity and of New Zealand citizenship or permanent residency.
If incorporated, attach evidence of incorporation in New Zealand and provide full names and dates of birth of each member of management.
Physical address of all permanent offices in New Zealand:
Physical address for delivery and service of notices:
Postal address (if different from physical address):
Details of person responsible for application
Direct-dial telephone number:
Scope limitation
Please provide details of any limitation on the scope that would apply to building control function work that would be undertaken if registration is granted.
Supporting information (attach separately as appropriate)
For the applicant and each member of management please provide details of—
any prior professional misconduct, such as disciplinary proceedings initiated or action taken by a professional institute or association; and
any civil claims made against that person in relation to contractual performance or tortious liability; and
any New Zealand or overseas convictions, or pending proceedings, in relation to dishonesty offences (such as fraud or forgery) or offences under enactments relating to building; and
any prior suspension, cancellation, or refusal of, or lapse in, status as—
a building certifier under the Building Act 1991; or
an accredited or registered building consent authority in New Zealand; or
any overseas equivalent building control authority; and
any prior building control experience in New Zealand or overseas.
Please provide evidence that the applicant holds a current accreditation from a building consent accreditation body appointed under section 248 of the Building Act 2004.
Please provide evidence that the applicant has adequate means to cover any civil liabilities that may arise in the performance of the functions of a building consent authority—including insurance policies or any other arrangements that provide for effective consumer protection (for example, by giving a bond or having a guarantor).
Please confirm that the applicant would have no conflicts of interest in fulfilling the role of a building consent authority and how the applicant would act to avoid such conflicts.
Statutory declaration
When you have completed the rest of this form, and all the supporting information has been prepared and attached, please take it to a Justice of the Peace, a Solicitor, or the Registrar or Deputy Registrar of the court to be witnessed. The declaration must be completed by a person who has legal authority to sign on behalf of the applicant. A significant penalty, including a term of imprisonment of up to 3 years, may be imposed under the Crimes Act 1961 for making a false declaration.
I, [full name and designation], solemnly and sincerely declare that—
*I am the applicant for which this licence application is being made
*I am authorised to make this application on behalf of the applicant
I have made all reasonable inquiries and the information contained in this application is true and correct to the best of my knowledge and belief and is accompanied by all relevant information known to the applicant.
Declared at [place] on [date].