Northern Territory of Australia Prostitution Regulation Act Section 9(2) Statutory Declaration by a Prostitute (1) Insert full name (2) Residential address (3) If you do not have one of these types of name (e.g. you are not married) please write “not applicable” in the appropriate blank space (4) Write down the town, the State or Territory and the country in which you were born (5) E.g. black, fair, olive (6) E.g. any tattoos or scars you may have and where they are on your body (7) Delete as applicable I, (1) of (2) previously resident at do solemnly and sincere declare as follows: My maiden name is (3) My married name is (3) My working name is (3) My alias or work name is (3) My date of birth is I was born in (4) Physical description: I am cm tall I weigh Kg My complexion is (5) The colour of my eyes are My natural hair colour is My present hair colour is I have the following distinguishing features (6) I (7) have / have not been convicted in the last 10 years of committing a serious drug offence or a violent offence, as those offences are defined in section 9(11) of the Prostitution Regulation Act, or of attempting to commit such an offence.
Notice In Accordance with the Information Act (Information Privacy Principle 1) Licensing NT (a division of NT Department of Business) is seeking information from you for the purposes of your application. Information Privacy Principle 1 (IPP 1) requires that a public sector organisation must not collect personal information unless the information is necessary for one or more of its functions or activities. If personal information about an individual is collected from the individual, the organisation must take reasonable steps to ensure that the individual is aware of certain matters. For the purposes of IPP 1, the following advice is provided. You are able to access your personal information that you have provided by making a written request to the Director-General of Licensing. The information is required pursuant to the Prostitution Regulation Act. The Act requires that certain matters must be considered when deciding whether or not to approve an application. The information will be kept confidential except as follows: Information may be sought from Police, government agencies, interstate licensing authorities, or referees or other persons nominated by you. Information may be released to those sources to the extent necessary to verify information about you and your application. Registers of licences and permits will be maintained and may be made available to the public on request. You do not have to provide information if you do not wish to do so. However, an application may not be approved if there is insufficient information to properly determine the matter in accordance with the Act. Territory Business Centres - Toll free: 1800 193 111, e: Darwin Ground Floor, Development House 76 The Esplanade Darwin GPO Box 9800 Darwin NT 0801 t: (08) 8982 1700 f: (08) 8982 1725 Katherine Shop 1, Randazzo Building 18 Katherine Terrace Katherine PO Box 9800 Katherine NT 0851 t: (08) 8973 8180 f: (08) 8973 8188 Tennant Creek Shop 2, Barkley House Cnr Davidson and Paterson Street Tennant Creek PO Box 9800 Tennant Creek NT 0861 t: (08) 8962 4411 f: (08) 8982 1725 Alice Springs Ground Floor, The Green Well Building 50 Bath Street Alice Springs PO Box 9800 Alice Springs NT 0871 t: (08) 8951 8524 f: (08) 8951 8533