Promoters application - Office for Recreation and Sport
Promoters application - Office for Recreation and Sport
Promoters application - Office for Recreation and Sport
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BOXING AND MARTIAL ARTS ACT 2000SOUTH AUSTRALIAAPPLICATION FOR PROMOTER’S LICENCEI apply to be registered/re-registered as a boxing <strong>and</strong>/or martial arts promoter.SECTION 1DETAILS OF INDIVIDUAL APPLICANTTitle Mr Mrs Ms Miss DrSurname: _________________________________________________________________Full Given Names: __________________________________________________________Date of Birth: ______________________________________________________________Residential Address: ________________________________________________________Telephone Home: ______________________ Telephone Work: ___________________Mobile: ______________________________Facsimile: ____________________________ Email: ____________________________Postal address: _____________________________________________________________(if the same residential address write “as above”)SECTION 2ENTITLEMENT TO BE REGISTEREDPlease answer Yes or No to the following questions in the space provided below, or on aseparate sheet of paper if the space provided is insufficient.Q1. Have you ever held or do you hold a promoter’s licence (or an equivalent licence) inanother State, Territory or Country? If yes, please provide a copy of your licence.Yes No______________________________________________________________________
- 2 -Q2. Have you ever been convicted of an offence (other than a traffic offence) or are anycourt proceedings pending?(Note - you are required to provide a National Police Clearance Certificate with your<strong>application</strong>). If yes, please provide details. Yes No______________________________________________________________________Q3. Have you ever been suspended or disqualified from practising or carrying on anoccupation, trade or business in this State or elsewhere? If yes, please provide details.Yes No______________________________________________________________________Q4. Are you an undischarged bankrupt or subject to a Composition, Deed, Scheme ofArrangement with or <strong>for</strong> the benefit of creditors? If yes, please provide details.Yes No______________________________________________________________________Q5. Have you during the last 5 years, been a director of a Body Corporate that has beenwound up <strong>for</strong> the benefit of creditors? If yes, please provide details. Yes No______________________________________________________________________SECTION 3APPLICATION DECLARATIONI, the applicant described in this <strong>for</strong>m, do solemnly <strong>and</strong> sincerely declare that:• I have read the Boxing <strong>and</strong> Martial Arts Act 2000 <strong>and</strong> Regulations <strong>and</strong> underst<strong>and</strong> mylegal obligations if the <strong>Promoters</strong> Licence is granted; <strong>and</strong>• the contents of this Application Form <strong>and</strong> attachments are true <strong>and</strong> correct <strong>and</strong> that Iunderst<strong>and</strong> that providing false or misleading in<strong>for</strong>mation is an offence under Section18 of the Boxing <strong>and</strong> Martial Arts Act 2000.I also authorise the Minister <strong>for</strong> <strong>Recreation</strong>, <strong>Sport</strong> <strong>and</strong> Racing to make any inquiriesnecessary <strong>for</strong> the purpose of determining this <strong>application</strong>.I acknowledge that in<strong>for</strong>mation contained in this <strong>for</strong>m may be made available to interstaterecognised authorities.Signature: _____________________________________________ _______________(of Applicant)(date)
- 3 -SECTION 4ADDITIONAL INFORMATION REQUIRED1. A National Police Clearance Certificate (must be an original document). The certificatemust be no more than three (3) months old preceding the date of lodgement of the licence<strong>application</strong>. To obtain this certificate you need to apply directly to the South AustraliaPolice.2. Application fees, (cash, cheques or money order) in the sum of $200.00 shall accompanythis <strong>application</strong> <strong>and</strong> be made payable to the <strong>Office</strong> <strong>for</strong> <strong>Recreation</strong> <strong>and</strong> <strong>Sport</strong>.3. Two recent passport photographs of the Applicant.LODGEMENT OF COMPLETED APPLICATIONPlease return your completed <strong>application</strong> <strong>for</strong>m with fee to:Boxing <strong>and</strong> Martial Arts Compliance <strong>Office</strong>r<strong>Office</strong> <strong>for</strong> <strong>Recreation</strong> <strong>and</strong> <strong>Sport</strong>27 Valetta RoadKidman Park SA 5025Ph: 8416 6627IMPORTANT INFORMATIONA copy of the Boxing <strong>and</strong> Martial Arts Act 2000 <strong>and</strong> Regulations can be obtained fromIn<strong>for</strong>mation SA, 77 Grenfell Street, Adelaide, telephone (08) 8204 1900.