Application pack for trans-tasman mutual recognition arrangement
Application pack for trans-tasman mutual recognition arrangement
Application pack for trans-tasman mutual recognition arrangement
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CONSENT TO DISCLOSURE OF INFORMATION<br />
Licensing & Vetting Service Centre<br />
Police National Headquarters<br />
Note:<br />
1. Please send this <strong>for</strong>m to the Authority with your application.<br />
2. Do not send this directly to the Police.<br />
I,.....................................................................................................................................................................................<br />
(Surname)<br />
(First Names)<br />
.......................................................................................................................................................................................<br />
(Maiden or any other names used)<br />
Sex...............(M/F)<br />
Nationality.........................................................................................................................<br />
Date of birth.........................................<br />
Place of birth.............................................................................................<br />
Residential Address......................................................................................................................................................<br />
Suburb................................................................<br />
City..............................................................................................<br />
NZ Driver Licence number .......................................................<br />
Card Version Number (5b)................<br />
Expiry Date (dd/mm/yyyy) …..…../…..…../……….<br />
authorise disclosure to the Real Estate Agents Authority by New Zealand Police of ANY in<strong>for</strong>mation that may<br />
be held by Police, including any interaction I have had with Police in any context or any in<strong>for</strong>mation received<br />
by Police. I understand that this is not limited to conviction in<strong>for</strong>mation.<br />
Where that in<strong>for</strong>mation relates to any record of criminal convictions I might have, I understand that it will<br />
automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records<br />
(Clean Slate) Act 2004.<br />
Vetting can only be carried out with the consent of the applicants, as evidenced by the signature and date as<br />
follows:<br />
Signed ............................................................................... Date ......................................................................<br />
Office Use only<br />
COMMENTS OF THE NEW ZEALAND POLICE<br />
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