AQF Certificate Replacement Application

AQF Certificate Replacement Application
Why are you applying for, or replacing, your AQF certificate? *

Certificate has been lost, stolen or damaged Did not receive a certificate after training was completed
Please provide details *
Course Details: *
Which certificate are you requesting? *

Aquarium Diver - $1.00 Aquaculture Diver - $30.00 Part 1 Restricted (Restricted SCUBA to 30m) - $30.00 Part 1 Diver (SCUBA to 30m) - $30.00 Part 2 Diver (SSBA to 30m) - $30.00 Part 3 Restricted diver (Restricted SSBA to 50m) - $30.00 Part 3 Diver (SSBA to 50m) - $30.00 Part 4 Diver (Closed Bell) - $30.00 Part 1 Supervisor (SCUBA to 30m) - $30.00 Part 2 Supervisor (SSBA to 30m) - $30.00 Part 3 Supervisor (SSBA to 50m) - $30.00 Diver Medical Technician (DMT) - $30.00
Applicant Details
ADAS Number
Name *

First Name Last Name
Postal Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Mobile/Cell *
Email *
example@example.com
Will your employer be paying for your application? *

Yes No
Employers Billing Address

If your employer will be paying for your application, please enter the company details here
Company Contact Details *

Company Name

Address

Contact name 1 Contact name 2

Email Country
Company Billing Address *

Address Line 1

Address Line 2

City State/Province/Region

ZIP/Postal Code Country
Supporting Documents
Please upload the documents below:
- A high-quality passport-style photo (Photo to be taken within the last twelve (12) months).
- A high-quality copy of your passport or alternative identification (e.g. drivers licence, ID Card).
Passport-Style Photo: *
Passport / Drivers Licence / ID Card *
Declaration
I understand and warrant that, by my submission of all information herein electronically, I acknowledge that all information is submitted on the basis that it is truthful in its entirety and has the same effect as if I had personally executed this application. I understand that my electronic submission of the information herein, entitles ADAS, its Officers, Servants and/or Agents, to rely upon same as being truthful and accurate and I indemnify, and keep indemnified, all Parties that rely upon the information electronically submitted therein in the event that any such information is found to be false and/or misleading.

Additionally, I understand, and agree to abide by, the conditions set out in the "Conditions of ADAS Certification".
Payment

Note: GST is applicable to Australian destinations only.
Australian Shipping Cost (inc GST)

$4.95
International Shipping Cost

22.00
GST
Total Order Price old
Total Order Price
How would you like to pay? *

Credit Card/Paypal Bank Cheque or Money Order
IMPORTANT: Do not close your browser once payment is submitted.

If you're paying by credit card or PayPal, you will be transferred to a secure payment page when you click submit. Once the payment process is completed you will be returned to our website. Please wait till you are returned to the website before closing your browser. If you close the browser before this time we may not receive your order.
If your company is paying for your application/order please ensure you enter all the relevant details in the 'Billing Address' section.
Please make cheque or money order for payable to:

"ADAS" and mail to 526 Duncan Road, Dunoon, NSW, 2480. Please allow approximately 7-10 working days for payment to be received.
Total Payment Due

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First Name	Last Name
Credit Card Number	Security Code
Card Expiration

AQF Certificate Replacement Application

Applicant Details

Employers Billing Address

Supporting Documents

Declaration

Payment

IMPORTANT: Do not close your browser once payment is submitted.