Form 4 - CSLB

Application for a Licence to Undertake Cadastral Surveys

For applicants with non accredited qualifications from countries other than New Zealand or Australia For Year 1 July 2020 – 30 June 2021

In terms of Part 3 of the Cadastral Survey Act 2002

Full Name

Email

Address

Phone

Please Enclose:

1. A copy of your NZIS Certificate of Competency or copies of other documents as evidence that you have met the Board’s Standards for Licensing.

The Board recognises the Certificate of Competency as being valid for up to twelve months after its date of issue if it was issued after 13 June 2014. If it was issued before 13 June 2014 it is valid for up to three years from the date of issue. If your application falls outside these times then you must comply with the requirements of s 3.1 of the Board’s Standards for Licensing.

2. Licence fee of $220.00 ($191.30 plus 28.70 GST).

(Note: The Board will reduce this fee to $115.00 incl GST if it issues the licence after 1 January, for the balance of the year to 30 June).

Please answer the following questions for the Board’s reporting and statistical purposes

Date of Birth

Gender

Male

Female

Ethnic Group

European

Maori

Pacific

Asian

American

African

Other

I confirm that I have read the Board’s Standards for Licensing, dated April 2013, (See Standards for Licensing) and meet all the competencies outlined therein. In terms of section 23 of the Cadastral Survey Act 2002, I hereby certify that within the last 5 years I have not been convicted of any offence under sections 217 to 281 of the Crimes Act 1961.

CSLB Form 4
Address: PO Box 1208 Wellington 6140