Document ID: chunk:federal_register_of_legislation:F2024N00656:schedule:3
Version: federal_register_of_legislation:F2024N00656
Segment Type: schedule
Provision Reference: sch 3
Character Range: 19659–21492

Schedule 3— Approved form - Application to Vary a Permit to Export a Class B Object or Certificate of Exemption

Application to vary a Permit to Export a Class B Object or Certificate of Exemption

Permit or Certificate holder details
Title:
First name:
Surname:
Organisation:
Address:
State:
Postcode:
Country:
Telephone:
Mobile:
Email: (see note below)

Note: The Department will correspond with you in relation to your application, including providing the outcome of your application and any reasons for decision, via the email address included in your application form, unless you indicate another preference.

Permit or Certificate details
Permit or Certificate reference number:  PMC
Name of the Object(s):

Permit or Certificate variation details
What do you wish to do?              o impose a condition to which the Permit or Certificate is to be subject;
                                     o vary or revoke a condition of the Permit or Certificate;
                                     o vary the period of effect of the Permit or Certificate; or
                                     o revoke the Permit or Certificate.
Why do you wish to have it changed?

Your statement
I understand and agree that:
    * if a variation to the Permit or Certificate is granted, that Permit or Certificate may be relied on only for the export of the object(s) or collection described in the Permit or Certificate;
    * if a variation to the Permit or Certificate is granted, it does not provide authority to export the object(s) otherwise than under the Act;
    * information provided in this application may be published on the Department's website, including the name of the object(s), as well as any unique identifiers such as serial numbers.

I declare that all information given in this application is correct.
Signed:
Date: