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    Interim Certificate Amendment: Use This Form If

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    dimuthh7441
    This document is an application form for amending incorrect details on an interim certificate issued by the Office of Liquor, Gaming and Racing in New South Wales, Australia. It explains that the form should be used if the applicant's details are incorrect on their interim certificate and they have not yet applied for their photo ID competency card. It provides instructions on completing and submitting the form, which includes filling in the applicant's incorrect details according to the interim certificate, providing their correct details to match their 100 points of ID, and obtaining details and signatures from their approved training provider and themselves.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Interim Certificate Amendment: Use This Form If

    Uploaded by

    dimuthh7441
    260 views2 pages
    This document is an application form for amending incorrect details on an interim certificate issued by the Office of Liquor, Gaming and Racing in New South Wales, Australia. It explains that the form should be used if the applicant's details are incorrect on their interim certificate and they have not yet applied for their photo ID competency card. It provides instructions on completing and submitting the form, which includes filling in the applicant's incorrect details according to the interim certificate, providing their correct details to match their 100 points of ID, and obtaining details and signatures from their approved training provider and themselves.

    Original Description:

    Certificate for oldrr

    Original Title

    Interim Certificate Amendment

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    This document is an application form for amending incorrect details on an interim certificate issued by the Office of Liquor, Gaming and Racing in New South Wales, Australia. It explains that the form should be used if the applicant's details are incorrect on their interim certificate and they have not yet applied for their photo ID competency card. It provides instructions on completing and submitting the form, which includes filling in the applicant's incorrect details according to the interim certificate, providing their correct details to match their 100 points of ID, and obtaining details and signatures from their approved training provider and themselves.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    260 views2 pages

    Interim Certificate Amendment: Use This Form If

    Uploaded by

    dimuthh7441
    This document is an application form for amending incorrect details on an interim certificate issued by the Office of Liquor, Gaming and Racing in New South Wales, Australia. It explains that the form should be used if the applicant's details are incorrect on their interim certificate and they have not yet applied for their photo ID competency card. It provides instructions on completing and submitting the form, which includes filling in the applicant's incorrect details according to the interim certificate, providing their correct details to match their 100 points of ID, and obtaining details and signatures from their approved training provider and themselves.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    RSA/RCG

    Application form

    Interim certificate amendment


    Use this form if:
    The details on your interim certificate appear incorrectly and you
    have not yet applied at Australia Post for your competency card.
    Note: Information on your interim certificate has been entered
    by your training provider. If there are errors on your certificate,
    please complete this form.
    DO NOT use this form if you already have your photo ID
    competency card and need to change your name as it appears
    on the card. To change your name on the card you must use the
    Replacement Card form, CC0500.
    1. Complete all questions. If information is missing, it will delay
    processing time as we will have to contact you to obtain
    the information.

    CC0300

    OFFICE USE ONLY


    By (circle): mail | OTC | fax | email

    Date lodged
    Request number
    Finalised by
    Date finalised

    2. If you need help in completing this application, call (02) 9995 0900 during business hours or email [email protected]
    3. For more information visit www.olgr.nsw.gov.au/photocard.asp
    4. Lodge this application form by:
    Post
    Office of Liquor,
    Gaming & Racing
    GPO Box 7060
    Sydney NSW 2001

    Deliver to
    Office of Liquor,
    Gaming & Racing
    Level 6, 323 Castlereagh St
    Haymarket NSW 2000

    Email
    [email protected]

    THIS FORM CONTAINS FILLABLE FIELDS

    PART A

    DETAILS ON INTERIM CERTIFICATE (including all incorrect details)

    Title

    Surname

    Given name

    Middle name

    Date of birth (dd mm yyyy)


    Certficate no.
    Form continues on next page...

    Interim certificate amendment CC0300 1012 v.1202

    1 of 2

    RSA/RCG
    Application form

    PART B

    YOUR CORRECT DETAILS (must correspond with your 100 points of identity)

    Which details need to be changed on your certificate? (e.g. given name and date of birth)

    Please complete all following details, even if they are correct or do not show on your interim certificate
    Title

    Surname

    Given name

    Middle name

    Date of birth (dd mm yyyy)


    Residential address
    Street no.

    Street name

    Town/city

    State

    Postcode

    State

    Postcode

    Postal address (if different to above)


    PO box or street no.

    Street name

    Town/city
    PART C

    STUDENT CONTACT DETAILS

    Phone (daytime)

    Phone (mobile)

    Phone (home)
    Email address
    PART D

    APPROVED TRAINING PROVIDER DETAILS

    RSA Interim Certificate (please tick)

    Yes

    No

    RCG Interim Certificate (please tick)

    Yes

    No

    Name of Approved Training Provider(s)


    Date(s) of course completion (dd mm yyyy)
    PART E

    DECLARATION

    I declare that the information I have provided is true, correct and complete and that I have made all reasonable enquires to obtain the
    information required to complete this form
    I acknowledge that the failure to provide all required information may result in an inability to process your application
    I acknowledge that it is an offence to provide false or misleading information
    I understand that specific details I have provided may be personal information under the Privacy and Personal Information
    Protection Act 1998.

    Name

    Signature

    Date
    Interim certificate amendment CC0300 1012 v.1202

    2 of 2

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