| First name |
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| Last name |
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| Business name |
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| Street address |
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| Suburb/town |
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| State |
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| Postcode |
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| ABN |
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| Phone number |
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| Email address |
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| Is this request for an Electrical or Non-Electrical Authorised Person? |
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| Authorised Person approval when granted will only apply to working near electric lines and does not permit contact with electric lines. |
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| This application does not guarantee approval and is subject to an assessment. I understand a letter of authorisation will be issued upon approval. |
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| All of the information provided in this application is true and correct to the best of my knowledge. |
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| Training evidence certificates attached for each person. |
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