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Declaration

Duties Form: Registration Form for Approved Livestock Agent

Fields marked with * are required

Collection statement

This information is collected by the SRO to establish whether your are eligible to be registered as an approved agent for the purposes of Chapter 10 of the Duties Act 2000 and Part 6 of the Livestock Disease Control Act 1994. If you do not provide the information required, we may not be able to process your application for registration. The information collected may be used for the purposes of other SRO legislation. Where authorised by law to do so, we may also disclose this information to other government agencies including the ATO, State and Territory revenue offices, and law enforcement agencies. You can find out more about how we use and protect your information in our Privacy Policy on www.sro.vic.gov.au.

Declaration

I declare that I am authorised to make this declaration.

The information provided on this form and in any attached documents is complete and correct. I understand that penalties apply for giving false or misleading information or omitting information.

The Electronic Transactions (Victoria) Act 2000 establishes the regulatory framework for transactions to be completed electronically. This form requires you to complete an electronic signature via tick-box before lodgment. By ticking the box you indicate your approval of the contents of this electronic communication.

Date

Signature

Date (DD/MM/YYYY)

First name

Middle name(s)

Family name

Position (if applicable)

Organisation (if applicable)

Mobile number

Phone number

Email

Applicant details

Duties Form: Registration Form for Approved Livestock Agent

Fields marked with * are required

Applicant details

Name

Trading name (if different from above)

ABN (if applicable)

Details of partners (if applicable)

Partner

First name

Middle name(s)

Family name

Mobile number

Phone number

Email

Registration details

Duties Form: Registration Form for Approved Livestock Agent

Fields marked with * are required

Trading locations

Specify the physical locations of all branches or other places in Victoria where the applicant carries on or proposes to carry on business as a stock agent.

Location

Address

Country

What is the type of address?

Street

PO Box

Lot number

Floor/Level type

Floor number

Flat/Unit type

Unit number

PO Box number

Post office name

Lot number

Street number

Street name

Street type

Suburb/Town

State

Postcode

International address

Street address/Postal address

Suburb/Town

State

Postcode/Zipcode

Overseas Address

Registration type(s)

I/we being a person/firm/partnership/company carrying on business as a livestock agent, apply to be registered as an approved agent for the purposes of Chapter 10 of the Duties Act 2000 and Part 6 of the Livestock Disease Control Act 1994.

Please advise, by selecting the boxes below, which of the following you will be collecting duty on.

Cattle

Sheep and goats

Swine

*Please note that Cattle Compensation, Sheep and Goat Compensation and Swine Compensation are maintained and administered as discrete funds. Because of this, separate collections are required on separate return forms.

Declaration

Collection statement

Declaration

Applicant details

Applicant details

Partner

Registration details

Contact details

International address

International address

International address

Trading locations

Location

International address

Registration type(s)