AVIATION SECURITY IDENTIFICATION CARD (ASIC) APPLICATION FORM

AVIATION SECURITY IDENTIFICATION CARD (ASIC) APPLICATION FORM APPLICANTS INFORMATION (to be completed by applicant please use BLOCK CAPITALS only) Given Names: Surname: Company: PLEASE NOTE: Applications must be submitted at least 6 weeks prior to requiring your ASIC Applications must be submitted in person by appointment Original Identification documents and/or certified copies must be provided with the application at the time of lodgement The ASIC Awareness presentation must be completed prior to submitting the application. This can be completed at www.hobartairport.com.au/asic ENQUIRIES & APPOINTMENTS HOBART INTERNATIONAL AIRPORT PTY LTD 6 Hinkler Rd Cambridge TAS 7170 P 6216 1600 E info@hobartairport.com.au W www.hobartairport.com.au/asic HIAPL OFFICE USE ONLY ASIC No H B New Renewal Replacement Temporary Application Rec:.. /.. /.. AUSCHECK Sent:.. /.. /.. DIAC Sent:.. /.. /.. ASIC Issued:.. /.. /.. AUSCHECK Rec:.. /.. /.. DIAC Rec:.. /.. /.. ASIC Expiry:.... /... AUSCHECK number:.... Photo number:... Card Validity HBA AUS Card Colour (Security Area) Red Grey Airside driving area limit 0 2 4 Comments: Page 1 of 10

Conditions of Use The following Conditions of Use must be agreed to prior to an ASIC being issued. The Card is issued subject to the Aviation Transport Security Regulations 2005 and to the Hobart International Airport Pty Ltd ASIC Program, approved under the Regulations. The Card is to be properly displayed, on the outer clothing at or above waist height on the front of the body and with the front face of the Card clearly visible when entering, remaining on, or leaving the relevant Security Restricted Area. The Card may only be used during the holder s approved duties in the relevant Security Restricted Area. It does not constitute an authority to enter or remain in the area for any other purpose. The Card must be presented for inspection on demand by a HIAPL employee or an Authorised Person. The holder of a Card, the holder s belongings, and the holder s vehicle may be subject to a search by a HIAPL employee or an Authorised Person before entering, while within or when leaving a Security Restricted Area or an Enhanced Inspection Area. The Card remains the property of Hobart International Airport Pty Ltd. A Card is issued on a personal basis and cannot be transferred to any other person. The Card must not be altered or defaced in any way. Loss of the Card is to be reported immediately to Hobart International Airport Pty Ltd at (03) 6216 1600. The Card must be returned to Hobart International Airport Pty Ltd; on expiry; if no longer employed by the sponsoring employer; if no longer has an operational need or on request of a HIAPL Manager. The holder must return an expired card to HIAPL within seven days of the expiry date. If there are any changes in circumstances to any part of this application, including the personal consent form, Hobart International Airport Pty Ltd must be advised immediately in writing at info@hobartairport.com.au. Hobart International Airport Pty Ltd may alter the terms and conditions on which a Card is issued at any time. The APPLICANT and their EMPLOYER are bound by the above conditions of use, and will be responsible for any breaches of the conditions of use by the holder of the Card. Charges apply for the application and production of an ASIC. See Part 4 for details on the applicable charges. All charges are payable upon submission of application. Definitions of terms can be found in the Aviation Transport Security Regulations 2005 I confirm that I viewed the presentation and completed a test on its contents. I accept and will abide by the conditions above. Page 2 of 10

PART 1 To be completed by the Applicant (Please use BLOCK CAPITALS only) Section A Personal Details To be completed by ALL applicants Date of Birth: Gender: Male Female Place of Birth: (e.g. Town & ) Country of Citizenship Previous Name (e.g. Maiden Name): Section B Contact Details To be completed by ALL applicants Residential Address Resident from Date: Note: You are required to provide your residential history for the past 10 years in Section C. Postal Address (if different from above) PO Box from Date: Phone Numbers: Home: Work: Mobile Email: Page 3 of 10

Section C Address History To be completed by ALL applicants It is mandatory for all applicants to supply 10 years of residential Address history. Address 1 Date From: Date To: Address 2: Date From: Date To: Address 3: Date From: Date To: Address 4: Date From: Date To: Address 5: Date From: Date To: Note: If you have more address details to add to this list please continue on a separate page and attach with your application. Page 4 of 10

Section D Non Citizen Details To be completed by the applicant only if you are not a citizen of Australia or New Zealand Please note, original or certified copies of your passport and visa documents must be supplied with your applications Date of Arrival into Australia: Immigration Visa Number Visa Expiry Date Passport Number: Arrival Details: Arrival Port: Airline Name & Flight Number: Vessel Name: Parents Surname (If entry was on parents passport): Parents Given Names (If entry was on parents passport) Section E Current ASIC Details To be completed by ALL applicants Do you hold a current ASIC? No Yes If Yes, complete below details ASIC Number ASIC Expiry Date ASIC Type HBA AUS Section F Acknowledgment To be completed by ALL applicants I, understand that I am applying for a security identifications card for the aviation industry. The information that I have provided in this application is correct to the best of my knowledge. I understand that my personal information will be used by AusCheck to co-ordinate a background check through the Australia Security Intelligence Organisation (ASIO), CrimTrac and the Department of Immigration and Citizenship (DIAC), where necessary. I have been given a copy of the AusCheck Privacy Notice, which explains how AusCheck will use my personal information. Page 5 of 10

PART 2 To be completed by the Employer (Please use BLOCK CAPITALS only) Section A Employer Details To be completed by the employer Company Name: Applicants Position Employer Phone Number: Work: Mobile: Employer Email Employer Postal Address Section B ASIC Required To be completed by the employer Please select the colour ASIC the applicant will require Red ASIC Grey ASIC Valid for airside security zones and secure areas of controlled airports Valid for landside secure areas, which are deemed to be areas within the sterile area of the terminal, of security controlled airports To be completed by the employer Please select the type of ASIC that is required. HBA AUS Is specific for use at Hobart international Airport only Australia wide access (Supporting letter to be included with application) Note: Applications for AUS ASICs must attach a supporting letter (on company letterhead) with this application, signed by a company authorised person stating the name of all ports where access is required, the frequency of access and the need for access at those ports. Page 6 of 10

Section E Operational Need To be completed by the employer Please provide a brief comment stating the reason the applicant requires an ASIC. This should include the type of duties being performed and the areas accessed during these duties. Note: This field must be completed for the application to be processed. Section F Employer Certification To be completed by the employer I, of confirm that the applicant and employer details are correct and request that an Aviation Security Identification Card (ASIC) be issued to the applicant for the areas indicated in this application I understand and agree to notify Hobart International Airport Pty Ltd (HIAPL) of any changes to the above particulars and to recover and return the ASIC prior to the applicant leaving our employ or upon transfer to a position which no longer has an operational need to retain the ASIC. I understand that HIAPL is not liable for any loss or damage sustained by the company as a result of non-issue of ASICs, or as a result of failure to honour the Conditions of Use for an ASIC and I agree to accept all applicable charges for the production of an ASIC. Page 7 of 10

PART 3 Information for the Applicant & Employer Section A Personal Identification to be provided To be provided by ALL applicants Prior to being issued with an ASIC, HIAPL must be provided with adequate personal identification. HIAPL must be provided with the originals or certified copies of the following: One (1) form of identification from the following: A Certified Birth Certificate A copy of a citizenship certificate Current valid Australian or foreign passport AND One (1) form of photo identification from the following: Current or Territory Licence Current Aviation Security Identification Card (ASIC) Australian Government employee identification card Australian student identification card OR One (1) form of identification from the FIRST list above plus two (2) from the following: Signed statement by employer Certified copy of Certificate of Title Document issued by rating authority about land ownership or occupation Extract from the electoral role Foreign Drivers Licence Identification requirements fulfilled (Office Use) Page 8 of 10

Section B Charges There are a number of charges involved with the background check and production of an ASIC. The below provides details on the applicable charges Initial Application: Full ASIC $215 Renewal Application Full ASIC $200 Replacement: ASIC $60 Temporary: ASIC $45 Note: - All charges are inclusive of GST - An additional charge of $7.85 applies if a DIAC check is required - $130 Inc. GST of the initial application is non-refundable once the application has been submitted for a background check - $110 Inc. GST of the renewal application is non-refundable once the application has been submitted for a background check - The balance of the fee is non-refundable once the production of your ASIC has begun - A $75 fee is applicable to those requiring access to the online ADA test. PART 4 To be Completed by the Applicant Section A Receipt of ASIC To be completed by the applicant upon receiving a new ASIC I acknowledge receipt of my ASIC which remains the property of Hobart international Airport Pty Ltd (HIAPL) and is on loan to me whilst I am employed in my current capacity by the company noted in this application. Page 9 of 10

PART 5 HIAPL Office Use Only Section A Identification Acknowledgment To be completed by HIAPL I, can confirm that I have received and verified the applicants identification as displayed in Part 4, Section A. Section B Operational Need To be completed by a HIAPL ASIC Delegate I, have reviewed the information provided by the applicant and employer in this application and can confirm that there is an operational need for the applicant to have an ASIC for Hobart International Airport Section C ASIC Return To be completed by HIAPL Please leave a note in the comments if a statutory declaration is submitted ASIC Return Required: No Yes Date Returned Section D AusCheck Conditions To be completed by a HIAPL ASIC Delegate Note HIAPL will receive the results of the background check from AusCheck. These results shall be attached with this application and the appropriate box shall be selected below. A Application is clear. ASIC may be issued for two years C Application is not clear. ASIC may be issued with conditions. N Application is not Clear. ASIC and/or VIC must NOT be issued to the applicant Section E ASIC Issuing To be completed by HIAPL ASIC Delegate I have reviewed the details displayed on the ASIC and confirm that they are correct. HIAPL requirements for an operational need have been met and the results of the background check conducted by AusCheck have authorised the issuing of an ASIC to the applicant. I hereby authorise the applicant to be issued with an ASIC by Hobart International Airport. Page 10 of 10