SafeWork NSW
Renewal Application Class A or Class B
Asbestos Removal Licence
June 2024
Complete this form to renew a licence for asbestos
removal work under the Work Health and Safety
Regulation 2017 (WHS Regulation).
Please note:
• if your ABN or ACN number has changed, a new
application for a Class A or Class B, Asbestos
Removal Licence will need to be submitted.
For more information about renewing your asbestos
removal licence refer to the SafeWork website
safework.nsw.gov.au/licences-and-registrations/licences
For SafeWork NSW to accept your application, the
form must be completed correctly, all supporting
documentation must be included and payment of the
prescribed fee MUST be included. Failure to do so will
delay the processing of your application.
How to fill in this form
Please type directly into the form. When complete save
a copy before emailing or printing. If completing by hand
please print clearly and mark box(es) with a tick
where required.
For assistance call 13 10 50
Fees
Refer to the SafeWork NSW fees schedule available at
safework.nsw.gov.au or call 13 10 50.
Lodgement instructions
Email: licensing@safework.nsw.gov.au
Identity documents
If the licence is held by a company, and there has been a
change of Director during the licence period, 100 points
of identification signed by a Justice of the Peace is
required for the new Director. Refer to Section 6.
Privacy Collection Notice
1. Who we are
Your information is being collected by SafeWork NSW, the
NSW Work Health and Safety Regulator. SafeWork NSW
gives priority to protecting the privacy of your personal
information, in accordance with the Privacy and Personal
Information Protection Act 1998 (PPIP Act) and Health
Records and Information Privacy Act 2002 (HRIP Act).
If you have any questions about this document, or how
we handle your personal information, you can contact our
Privacy team using the contact details at the end of this
notice.
2. Why we collect your personal information
SafeWork NSW is collecting your personal information
for the purposes of processing an application to renew
a Class A or Class B, Asbestos Removal Licence, in
accordance with the WHS Regulation.
3. Failure to provide information
Your information is provided voluntarily however if you
choose not to provide your information, we may be unable
to process your application.
4. How we may use this information
We may use the information we collect in the following
ways:
• To assess your application to renew a Class A or
ClassB, Asbestos Removal Licence, in accordance
with Part8.10 Division 5 of the WHS Regulation.
• Internal administrative purposes, including liaising
with you in relation to your application, and in relation
to compliance, investigations, and enforcement of the
Work Health and Safety Act 2011 (WHS Act) and the
WHS Regulation.
• To administer and update your licence, including to send
you information that we consider important such as
reminders to renew licences and to confirm your details
if you make any subsequent applications in relation to
any licence or authority issued by SafeWork NSW.
• To support more informed policy making, program
management, evaluation, research, and service
planning as it can facilitate more efficient service
delivery for residents and business in NSW.
SW09149 – Renewal Application Class A or Class B Asbestos Removal Licence
• To record information on a public register which is
published online (as required by clause 702B of the
WHS Regulation). This will include your name or your
business name, suburb, licence number, contact
number, email address, licence type and validity,
licence classes and conditions, associated compliance
history and the NSW region/s in which you provide
licensed services.
• To verify your proof of identity documents.
• Other directly related purposes.
5. Who we may share your information with
If required, we may make enquiries and exchange
information with other NSW Government agencies, or
other States, Territories and/or the Commonwealth
for the purposes of assessing your application and for
compliance purposes. We may disclose your information
to such bodies for these purposes.
We will also disclose personal information to third parties
for the purpose of verifying the qualifications provided
in this application. Your personal information may also
be shared with third-party service providers engaged by
SafeWork NSW for the purpose of printing and mailing
your licence card to you.
We will not disclose your information to anybody else
unless we are authorised or permitted to do so by law or
where you have given consent. Our Privacy Statement
describes when this may occur.
6. Protecting your information
We will store and manage your information in accordance
with the provisions of the PPIP and HRIP Acts. We
have measures in place to help protect your personal
information from loss, unauthorised access, use,
modification, disclosure, or other misuse.
We will only keep information for as long as we need it
to fulfil the purposes we collected it for. After which, the
information will be disposed of securely in accordance
with the State Records Act 1998 and any other applicable
legislation.
See our Privacy Management Plan for more information
about how we handle your personal information.
7. Your rights
Subject to certain conditions, you have the right to access
or correct your personal information. If you wish to invoke
any of the above rights, please contact us using the
details below.
8. Contact us
If you would like to make a privacy enquiry or complaint,
you can contact us on (02) 9219 3999 or at
privacy@safework.nsw.gov.au
Section 1. Type of Licence
Asbestos licence number Licence holder’s name
Indicate the asbestos removal licence which you are applying to renew. Mark one box only.
Note: Class A licence holders are also authorised to carry out Class B asbestos removal work.
Class A
Class A (asbestos fire doors and safes only)
Class B (more than 10 square metres of non-friable asbestos)
Section 2. Licence holder details
Ensure all fields are filled out with current information relating to the business and nominated contact person.
Individual Corporation
Registered name
Registered business (trading) name (if applicable)
ABN
ACN
The ABN or ACN must be attached to the legal name entered above
Page 2
SW09149 – Renewal Application Class A or Class B Asbestos Removal Licence
Section 2.1 Individual Licence holder or Director on behalf of a corporation
Change of previous Director – 100 points of Justice of the Peace (JP) certified identity documents must be provided
with this application. Refer to details in Section 6.
Family name
Given name
Other names
Date of birth (DD/MM/YYYY)
Daytime contact number
Email
Business address for Corporations
Residential address for Individuals
(Must not be a PO Box)
Unit number/Street number/Property number
(include Lot or DP number if applicable)
Street name
Suburb
State Postcode
Section 2.2 Contact person
Licence applications will only be discussed with the contact person for the application, a Director or partner of the
entity applying for the licence.
Family name
Given name
Daytime contact number
Email
Section 3. Certified Safety Management System (CSMS)
Friable asbestos (Class A) licence holder is required to submit evidence they have a current CSMS in place that
complies with ISO 45001:2018 Occupational health and safety management systems – Requirement with guidance
for use, and be certified by a JAS-ANZ accredited certification body.
I am a Class A licence holder and have attached the current CSMS certification.
Section 4. Insurance
If you are an employer and not exempt under the Workers Compensation Act 1987 from holding a workers compensation
insurance policy, you must supply a certificate of currency for workers compensation insurance with this application.
Workers compensation insurance
I am an exempt employer under the Workers Compensation Act 1987
I have attached a copy of the certificate of currency for workers compensation
Page 3
Postal address
same as business/residential address
Unit number/Street number/Property number
(include Lot or DP/PO Box/GPO Box/Private Bag/Locked Bag)
Street name
Suburb
State Postcode
ACTNSWNTQLDSATASVICWA
ACTNSWNTQLDSATASVICWA
SW09149 – Renewal Application Class A or Class B Asbestos Removal Licence
Section 5. Nominated supervisor(s) details
If the nominated supervisor(s) details are unchanged please go to section 5.2.
If you are nominating a new supervisor or changing the personal details of an existing supervisor, complete
section5.1 and attach the Asbestos Removal Supervisor Nomination Form for each supervisor.
Section 5.1 New supervisor(s) or changing details
I am nominating a new supervisor / changing personal details of an existing supervisor.
Yes, and I have attached (insert number) of Asbestos Removal Supervisor Nomination Form(s)
No. Please go to section 5.2
Section 5.2 Remove supervisor
Are any nominated supervisor(s) previously listed on your licence required to be removed?
Yes. Please provide details below. No. Please go to Section 6
Name
Name
Name
Date of removal (DD/MM/YYYY)
Date of removal (DD/MM/YYYY)
Date of removal (DD/MM/YYYY)
Identity Documents
Section 6. Checklist of documents required
Use this checklist to ensure you have your required documents ready to submit with your application.
Certified Copies of Original Documents
A certified copy is a photocopy of the original document, certified as a true copy by a Justice of the Peace (JP).
The JP must declare on the photocopy:
• that it is a true copy of the original document
• the JP’s signature and date
• the JP’s registration number and the state where they are registered.
Change of previous Director – 100 points of JP certified identity documents
Copy of the Certificate of Currency for Workers Compensation
Class A licence holder only: Copy of current Certified Safety Management System certificate
Any required Asbestos Removal Supervisor Nomination forms are completed ready to submit with this application
Page 4
Document type Document Points
Primary documents
Only use one document Australian Birth Certificate / card issued by the Registrar of Births, Deaths and
Marriages
70
Passport – Australian or international (current or expired within the last two
years but not cancelled)
70
Australian citizenship certificate 70
Secondary documents
1. Allowed to use
a combination
of secondary
documents
2. Documents provided
must contain the
licence holder’s full
name (not initials)
Current Australian Driver’s licence / permit 40
Student card issued by a tertiary institution 40
Current Medicare card 25
Credit or debit card, passbook or account statement from a financial institution
(only one per financial institution can be counted)
25
Property lease agreement with current address 25
Utility bills issued in the last three (3) months 25
Telephone account issued in the last three (3) months 25
SW09149 – Renewal Application Class A or Class B Asbestos Removal Licence
Section 7. Disclosure statements
For legal purposes, the term ‘you’ on this page means:
• the licence holder
• in the case of a corporation – the corporation itself and each officer of the corporation
Have you been convicted or found guilty of an offence under the WHS Act or WHS Regulation or under the workplace
health and safety law of another state, territory or the Commonwealth?
Yes. If yes provide details No
Have you been convicted or found guilty of any offence in relation to the unlawful disposal of hazardous waste under
the Protection of the Environment Operations Act 1997?
Yes. If yes provide details No
Have you entered into an enforceable undertaking under the WHS Act or under the workplace health and safety law
of another state, territory or the Commonwealth?
Yes. If yes provide details No
Was there any condition(s) placed on the licence?
Yes. If yes provide details No
Was the licence suspended, cancelled or disqualified?
Yes. If yes provide details No
Section 8. Licence holder’s declaration
A Director must complete and sign this declaration on behalf of a Corporation.
Has the licence holder ensured asbestos removal work of the type authorised by the licence, been carried out during
the term of the licence period?
Yes
No
If no, please provide details why the licence holder has not carried out licensed asbestos removal work.
Page 5
SW09149 – Renewal Application Class A or Class B Asbestos Removal Licence
Section 8. Licence holder’s declaration (continued)
I (print name) declare:
• the information supplied in this application is true and correct to the best of my knowledge.
• I consent to SafeWork NSW making enquiries and exchanging information with work health and safety regulators
in other states, territories, or the Commonwealth regarding any matter relevant to this application.
• I confirm nominated supervior(s) on this licence have maintained their competency to carry out work covered by
the licence safely and competently.
• the licence holder does not hold an equivalent licence granted by a corresponding regulator under a corresponding
work health and safety law.
• I have read the privacy collection notice.
SafeWork NSW compiles a public register of asbestos removal licence holders on verify.licence.nsw.gov.au
Please mark the proposed region(s) you will operate in as per the SafeWork NSW region key map below.
A B C D E F G H I J K L M or ALL
J
K L
Wentworth
Wilcannia
Cobar
Hay
Bourke
Parkes
Yass
Bega
Cooma
Canberra
Deniliquin
Narrandera
Griffith
Albury
Goulburn
Dubbo
Orange
Narrabri
Lismore
Tweed Heads
Grafton
Port Macquarie
Newcastle
Toronto
Gosford
Wollongong
Wagga
Wagga
I
D
M
Finley
E
A
B
G
C
H
F
Broken Hill
Walgett
Coonamble
Moree
Tamworth
Nyngan Coonabarabran
Casino
Inverell
Glen Innes
Armidale
Kempsey
Taree
Gilgandra
Maitland
Bathurst
Sydney
Lithgow
Signature Date (DD/MM/YYYY)
A Director must sign on behalf of a Corporation
N
ote: It is an offence to make a false or misleading statement in applications under clause 268 of the WHS Act.
Penalties may apply.
Section 9. Fees and lodgement of form
Fees
A fee must be paid before lodging this application form. Refer to the SafeWork NSW fees schedule available at
www.safework.nsw.gov.au
Pay by credit card or PayPal using the following link: www.safework.nsw.gov.au/applicationpayments
Step 1 – Click on the link or type the URL into your web browser
Step 2 – Follow the instructions online to complete payment
Step 3 – When the lodgement fee is paid online you will receive a receipt number.
Please record the receipt number below before lodging the application; not providing this information may result in
delays in processing your application.
Receipt number
Note: If you are having difficulty lodging this payment online, please contact SafeWork NSW on 13 10 50.
Lodgement
Send completed form and required documents to: licensing@safework.nsw.gov.au
Page 6
