Principal Executive Officer declaration form (Charities)

This publication is for: 
Not for profit

When to use this form

This form is an integral part of any application for, or renewal of, a Charitable Collections Licence, and may also be used to advise of a change in office bearers or director of a licence holder.

Part of the responsibility of the Charitable Collections Advisory Committee is to ensure all licence holders, and those administering any organisation holding a licence, are fit and proper persons to deal with public collection monies. To assist with the exercise of this responsibility, all those persons who have been identified as a Principal Executive Officer are required to provide a National Police Certificate (no older than six months).


  • complete all parts if this form
  • print clearly and tick the boxes where appropriate
  • attach a National Police Certificate (no older than six months)
  • lodge your declaration (email preferred)

Lodging your form

The charities forms and publications page contains further details about:

  • how to lodge your form;
  • relevant fees; 
  • other charities forms; and 
  • how to contact us.
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Last updated 22 Aug 2018

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