Fit and Proper Person Declaration

Position title

RTO Legal name

RTO Trading name

RTO Number

Senior officer definition: A senior officer is a person (other than a Director or shareholder) who is in a position to influence the management of your organisation. It includes a person who makes, or participates in making decisions that affect the whole, or a substantial part of the business of your organisation or who has the capacity to significantly affect your organisation's operations or financial standing. Senior officers will typically include the members of the senior management team.

Have you or a Registered Training Organisation (RTO) in which you have been a senior officer ever:

1 Been refused registration as an RTO or had a registration cancelled by the VRQA or any other state, territory or Y N Commonwealth registering body?

2 Had registration as an RTO suspended by the VRQA or any other state, territory or Commonwealth registering body? Y N

3 Had conditions imposed on registration as an RTO by the VRQA or any other state, territory or Commonwealth registering Y N body?

4 Been convicted of an indictable offence under a law of the Commonwealth or of any Australian state or territory? Y N

5 Been convicted of a sexual offence? Y N

6 Been convicted of an offence that involves fraud or dishonesty? Y N

7 Been bankrupt or taken the benefit of any law for the relief of bankrupt debtors, or compounded with their creditors or made Y N an assignment of their property for their benefit?

8 Been part of a company or body that has been wound up? Y N

9 Been disqualified from managing corporations under Part 2D.6 of the Corporations Act 2001? Y N

10 Been convicted of an offence against the Consumer Act within the meaning of the Fair Trade Act 1999 or a law relating to Y N company administration or an offence equivalent to this in any Australian state or territory?

11 Been convicted of an offence against the ETR Act or a corresponding law of the Commonwealth or of any Australian Y N state or territory?

12 Been in breach of a government training contract? Y N If you answered Yes to more than one question in the previous section you must copy and complete this explanation section for each question and attach all completed sections to your statutory declaration.

Select which question/s you are referring 1 2 3 4 5 6 7 8 9 10 11 12 to

Add relevant details about your answer (if more space is needed please attach separate documents) Statutory Declaration

Made under the Evidence (Miscellaneous Provisions) Act 1958 (VIC)

I, (name)

(occupation)

do solemnly and sincerely declare that:  all the information I have provided in the attached Fit and Proper Person Requirements declaration is true, accurate and correct  I acknowledge that this declaration is true and correct and I make it with the understanding and belief that a person who makes a false declaration is liable to the penalties of perjury.

Declared at

this day of

Signature of person making this declaration (to be signed in front of an authorised witness)

Before me (signature of authorised witness)

The authorised witness must print or stamp his or her name, address and title under section 107A of the Evidence Miscellaneous Provisions Act 1958 (as of 1 January 2010) previously Evidence Act 1958. (eg Justice of the Peace, Pharmacist, Police Officer, Court Registrar, Bank Manager, Medical Practitioner, Dentist).

Name of Title witness

Address List of persons who may witness statutory declarations in Victoria

 a justice of the peace or a bail justice

 a public notary

 an Australian lawyer (within the meaning of the Legal Profession Act 2004)

 a clerk to an Australian lawyer

 the prothonotary or a deputy prothonotary of the Supreme Court, the registrar or a deputy registrar of the County Court, the principal registrar or a registrar or deputy registrar of the Magistrates' Court or the principal registrar or a registrar or deputy registrar of the Children’s Court

 the registrar of probates or an assistant registrar of probates

 the associate to a judge of the Supreme Court or of the County Court

 the associate of an Associate Judge of the Supreme Court or of an associate judge of the County Court

 a person registered as a patent attorney under Chapter 20 of the Patents Act 1990 of the Commonwealth

 a police officer

 the sheriff or a deputy sheriff

 a member or former member of either House of the Parliament of Victoria

 a member or former member of either House of the Parliament of the Commonwealth

 a councillor of a municipality

 a senior officer of a Council as defined in the Local Government Act 1989

 a person registered under the Health Practitioner Regulation National Law to practise in the medical profession (other than as a student)

 a person registered under the Health Practitioner Regulation National Law — (i) to practise in the dental profession as a dentist (other than as a student); and (ii) in the dentists division of that profession

 a registered veterinary practitioner within the meaning of the Veterinary Practice Act 1997

 a person registered under the Health Practitioner Regulation National Law to practise in the pharmacy profession (other than as a student)

 a principal within the meaning of the Education and Training Reform Act 2006

 the manager of an authorised deposit-taking institution

 a person who holds a prescribed membership of a prescribed accounting body or association

 the secretary of a building society

 a minister of religion authorised to celebrate marriages

 a Victorian Inspectorate Officer within the meaning of the Victorian Inspectorate Act 2011

 a person employed under Part 3 of the Public Administration Act 2004 with a classification that is prescribed as a classification to which this section applies or who holds office in a statutory authority with such a classification  an IBAC Officer within the meaning of the Independent Broad-based Anti-corruption Commission Act 2011

 a fellow of the Institute of Legal Executives (Victoria).