NSW Resources Regulator

FORM | CERTIFICATE OF COMPETENCE

Mutual recognition of statutory functionsMay 2023

WHS (Mines and Petroleum Sites) legislation

OverviewA person may seek registration for an equivalent occupation under the Mutual Recognition (New South Wales) Act 1992 (MR Act) or the Trans-Tasman Mutual Recognition (New South Wales) Act 1996 (TTMR Act) in relation to the equivalent statutory functions under Schedule 10 of the Work Health and Safety (Mines and Petroleum Sites) Regulation 2014 (WHS (Mines and Petroleum Sites) Regulation).

The mutual recognition of statutory functions info sheet includes information on applying for mutual recognition to carry out a statutory function in a NSW mine and.

InstructionsYou must read the info sheet before completing this application form.

Your application must be accompanied by the original or a copy of your existing registration document (or, if there is no such document, sufficient information to identify you and your registration must be provided) and certified documentation to verify your identity. All documentation must be certified by an independent authorised certifier.

Information about lodging your notification is provided at the end of this application form.

A separate form must be submitted for each statutory function you are seeking to notify for.

Personal detailsDetail required Complete details here

First name/s*      

Last name*      

Preferred name      

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NSW Resources Regulator

Detail required Complete details here

Salutation Mr Mrs Ms Miss Dr Other

Gender Male Female Other      

Date of birth(DD/MM/YYYY)      

Place of Birth(town/city, state)      

Country of Birth (if other than Australia)      

Home address(inc. suburb and postcode)      

Postal address(inc. suburb and postcode)      

Personal email address      

Work email address      

Home telephone      

Mobile      

Current place of employment**      

* Provide your full legal name** Only required if you are currently employed at a mine.

Notice requirementsa) State the occupation (for example, relevant statutory functions under Schedule 10 of the Work

Health and Safety (Mines and Petroleum Sites) Regulation 2014) for which registration for the equivalent occupation is sought:

Mining engineering manager of underground coal mines

Undermanager of underground coal mines

Deputy of underground coal mines

Mining engineering manager of coal mines other than underground coal mines

Open cut examiner of coal mines other than underground coal mines

Mining engineering manager of underground mines other than coal mines

Underground mine supervisor of underground mines other than coal mines

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NSW Resources Regulator

Quarry manager of mines other than underground mines or coal mines

NOTE: If you are seeking registration of an equivalent occupation in relation to a statutory function that is not listed above, contact 02 4931 6625.

b) Are you seeking registration of the above occupation (as indicated in question 4a) in accordance with the mutual recognition principle under the:Mutual Recognition (New South Wales) Act 1992 Yes NoTrans-Tasman Mutual Recognition (New South Wales) Act 1996 Yes No

c) Are you registered for the occupation (as indicated in question 4a) in another Australian State or Territory or New Zealand? Yes No

If yes, specify that State or Territory or New Zealand:

     

d) Specify all States, Territories or New Zealand in which you currently hold or previously held registration for the equivalent occupation (as referred to in question 4a above).

Issuing authority Registration document title Date of issue Current or expired

                       

                       

                       

                       

NOTE: The original or a copy of your existing registration instrument (or document) must accompany your notification form. If there is no such instrument, provide sufficient information to identify your registration must be provided. For further information, contact 02 4931 6625.

e) Are you the subject of disciplinary proceedings in any State or Territory or New Zealand (including any preliminary investigations or actions that might lead to disciplinary proceedings) in relation to the occupation? Yes No

f) Is your registration in any State or Territory or New Zealand cancelled or currently suspended as a result of disciplinary action? Yes No

g) Are you otherwise personally prohibited from carrying on any such occupation in any State or Territory or New Zealand, and subject to any special conditions in carrying on that occupation, as a result of criminal, civil or disciplinary proceedings in any State or Territory or New Zealand?

Yes No

h) Are you subject to any special conditions in carrying on any such occupation in any state or territory or New Zealand? Yes No

If yes, specify the special conditions:     

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NSW Resources Regulator

i) Do you give consent to the regulator (i.e. head of the Department of Industry) making inquiries of, and the exchange of information with, the authorities of any State or Territory or New Zealand regarding your activities in the relevant occupation or occupations or otherwise regarding matters relevant to this notification? Yes No

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NSW Resources Regulator

Identity verification documentsPlease tick the boxes below to indicate which documents are attached to your notification. You must attach a certified copy of all the documents provided. See section 4 of the information sheet for ‘How to certify documents’.

Group A documents - Must have name, date of birth and place of birth

Birth certificate

Citizenship certificate

Current passport

Expired passport that has not been cancelled and was current within the preceding two years

Other documents of identity having the same characteristics as a passport including diplomatic documents and some documents issued to refugees

Group B documents - Must have photograph, name and current residential address

Driver’s licence issued by an Australian state or territory

Roads and Maritime Services (formerly RTA) photo card

Identification card issued to a public employee

Identification card issued by the Commonwealth, a State or Territory government as evidence of the person's entitlement to a financial benefit

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NSW Resources Regulator

Statutory declarationI,      ______________________________________________________________________________________,

(full name of declarant)do solemnly and sincerely declare that:1. the statements and information provided in this notification are true and correct to the best of my knowledge;

and

2. any registration document attached to this notification is either the original or a complete and accurate copy of the original.

and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1900.

Declared at:      ______________________ on      ________________________________________________(place) (date)

____________________________________________________________________________________________(signature of declarant)

in the presence of an authorised witness, who states:

I,      _______________________________, a     _________________________________________________,

(full name of authorised witness) (qualification of authorised witness)certify the following matters concerning the making of this statutory declaration by the person who made it: (*please cross out any text that does not apply)

1. *I saw the face of the person OR *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.

2. *I have known the person for at least 12 months OR *I have confirmed the person’s identity using an identification document and the document I relied on was

     ________________________________________________________________________________________

(describe identification document relied on)

______________________________________________      _________________________________________

(signature of authorised witness) (date)(NOTE: An authorised witness is usually a justice of the peace or notary public.)

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NSW Resources Regulator

Fee paymentStatutory functions Fee

Mining engineering manager of underground coal mines $380

Undermanager of underground coal mines $360

Deputy of underground coal mines $340

Mining engineering manager of coal mines other than underground coal mines $380

Open cut examiner of coal mines other than underground coal mines $340

Mining engineering manager of underground mines other than coal mines $200

Underground mine supervisor of underground mines other than coal mines $100

Quarry manager of mines other than underground mines or coal mines $200

Please indicate below which method you are using to pay the fee:

I have attached a cheque or money order made payable to the Department of Planning and Environment

I have paid online by credit card.

Instructions to pay via the online payment system:

1. Go to www.regonline.com.au/mutualrecognition

2. Enter your email address, nominate the type of registration and select continue.

3. Enter your full name and create a new password with a minimum of 8 characters.

4. Enter your personal and credit card details.

5. Select finish.

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NSW Resources Regulator

ChecklistTo avoid delays in processing your notification and to confirm that your form is ready for submission, use this checklist.

Have you completed all the relevant fields in the personal details in section 1 of this form?

Have you completed all the notification requirements in section 2 of this form?

Have you provided identity documentation in section 3 of this form?

Have you completed the statutory declaration in section 4 of this form and had it witnessed?

Have you provided fee payment? See section 5 of this form.

Submitting the formWe prefer that notifications be submitted via email. Alternatively, you may mail or fax your notification form to us. Please only submit your notification form via one method.

Email: minesafety.competence@planning.nsw.gov.au (preferred option)

Mail: Mining Competence Team, Department of Planning and Environment,PO Box 344, HRMC NSW 2310

© State of New South Wales through the NSW Department of Planning and Environment 2017.

This publication is copyright. You may download, display, print and reproduce this material in an unaltered form only (retaining this notice) for your personal use or for non-commercial use within your organisation. To copy, adapt, publish, distribute or commercialise any of this publication you will need to seek permission from the NSW Department of Planning and Environment.

Disclaimer: The information contained in this publication is based on knowledge and understanding at the time of writing (May 2023). However, because of advances in knowledge, users are reminded of the need to ensure that information upon which they rely is up to date and to check currency of the information with the appropriate officer of the NSW Department of Planning and Environment or the user’s independent advisor.

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