APPLICATION FOR REPLACEMENT DOCUMENTATION
- A Statutory Declaration must accompany this application (see page 2).
- A fee is applicable (see fee structure below). Cheques/money orders should be made payable to the Receiver of Territory Monies (RTM). For direct deposit to a bank, see end of page 2.
Student Name...... Date of Birth......
Please Print -Family NameGiven Names
Name on original document if different to above......
Please Print - Family nameGiven Names
Postal Address......
Please Print
...... Postcode ......
TelephoneContact No:. Home...... Work...... Mobile......
School(s) attended......
Calendar Year to which the document/s applied......
Document/s to be replaced -
All documentation pertaining to (Please tick appropriate box/es):
Document TypeDetails Cost
Year 10 Statement of Results: (1984-1999)$22.00
Year 11 Statement of Results: (1981 onwards)$22.00
Record of Achievement: (this includes Year 11 and Year 12$22.00
& TER/ATAR if applicable 1996 onwards)
NTCE Certificate: (this includes Record of Achievement, 1996 - 2010)$50.00
NTCET Certificate: (this includes Record of Achievement, 2011 onwards)$50.00
Document has been lost, stolen, damaged, destroyed, never received or issued with errors.
Please circle the appropriate category
Note:Requests for replacement documents can be made only by the person who is named on the document except where the person is overseas or interstate. Application may then be made on behalf of students by parents or siblings and the Statutory Declaration on page 2 must be completed.
Requested by...... Signature......
Relationship to Applicant......
Conditions
- Attach the Statutory Declaration stating the circumstances for requiring replacement documentation.
- Attach the required fee, except if you seek a replacement due to error on the document. If the document has an error, attach the document and explain the nature of the error.
Note:
- Reprints for Year 10 are available from the Department of Education (DoE) from 1984 to 1999. Contact the school you attended for Year 10 reports from the year 2000 onwards.
- Reprints for Stage 1 (Year 11) are available from 1981 onwards from DoE.
- Reprints for Stage 2 (Year 12) are available from 1996 onwards from DoE.
- Reprints for Stage 2 prior to 1996 are available from the SACE Board of South Australia.
1
STATUTORY DECLARATION
(1)I, ......
Please Print - Name & Address of person making declaration
...... do solemnly and sincerely declare
Please Print
(2)That I have lost/misplaced my original certificate/statement......
Please Print – The matter declared to – i.e. name of replacement document(s) requested and reason for request (lost/damaged etc).
And I make this solemn declaration by virtue of the Oaths Act and conscientiously believe the statements contained in this declaration to be true in every detail.
Declared at:......
The ...... Day of ...... Year......
(3)
Signature of person making the declaration
(4)
Signature of person before whom the declaration is made (witness)
(5)
......
Please Print – Name and contact address or telephone number of the person (witness) before whom the declaration is made.
......
NOTE: A person willfully making a false statement in a statutory declaration is liable to a penalty of $2,000 or imprisonment for 12 months, or both.
6)This declaration may be made before any person over the age of 18 years.
The NTCETCertification Officer will advise a date when the Replacement Documentation will be available for collection, or you can request for it to be posted to you. You will need to complete this form, pay the appropriate fee to the RTM (Receiver of Territory Monies) or electronically using Direct Deposit, then have your receipt and application form faxed, posted or delivered to the Certification Officer at the contact details on the bottom of this form.
PAYMENT MADE USING DIRECT DEPOSIT OR INTERNET
Direct depositsfor payment of Certificates can be made at a National Bank branch or on internet banking using:
BSB: 085-461A/C Number: 351610000A/C Name:RECO DARWIN, students must ask the bank when making a deposit to quote the following reference “ARD – Your Surname”. Please fax or Email a copy of your receipt and application form to the NTCETCertification Officer at the contact details on the bottom of this form.
PAYMENT MADE AT AN RTM OFFICE
Cheque/cash deposited to Account Code 350109-166911; GST Code S10
RTM offices are located in:
Darwin / 8999 1606 / Level 7, Charles Darwin Centre, 19 The Mall, DarwinCasuarina / 8943 6219 / The Domain, 16 Scaturchio Street, Casuarina
Alice Springs / 8951 6491 / 1st Floor Alice Springs Plaza
Katherine / 8973 8715 / Level 1, Katherine Government Centre, First Street, Katherine
RTM office hours are 08:30 - 16:00, Monday to Friday.
RTM Office use onlyARD form and receipt faxed to NTCETCertification Officer
RTM receipt number...... Date......
NTCET Certification Officer, Senior Years Curriculum, 11th Floor Mitchell Centre,
55-59 Mitchell St, Darwin NT 0800 or GPO Box 4821, Darwin 0801
Phone:(08) 89449253 or (08) 89449254
Email: