The Laws of Fiji
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When completing this application please ensure that all sections are completed and that all requested information is provided
Official use only
Registration No
Fee payable $................................................................ (see below)
| Section 1 | Tick consultant category applied for— |
| □ | Principal consultant |
| □ | Technical assistant |
| □ | Assistant consultant |
| □ | Review consultant |
| Section 2 | Personal Information |
| Family Name: | |
| Given Name: | |
| Prefix/Title: | |
| Address: | |
| Telephone: | |
| Mobile: | Fax: |
| E-mail: |
Section 3
Details of any company or partnership of which the consultant is a member or employee:
Company or firm name and address
Position in company or firm
Section 4 Qualifications
List professional qualifications as an environmental consultant.
If none, set out details of experience in environmental consultancy work in the category applied for.
Section 5 Previous application
| □ | No previous application for registration as a consultant | ||
| □ | Previous application— | ||
| □ | As a principal consultant | ||
| Date | Result | ||
| □ | As a technical assistant | ||
| Date | Result | ||
| □ | As an assistant consultant | ||
| Date | Result | ||
| □ | As a review consultant | ||
| Date | Result | ||
Section 6 Declaration
I hereby apply for registration/renewal of registration as—
□ Principal consultant
□ Technical assistant
□ Assistant consultant
□ Review consultant
for purposes of the Environmental Management (EIA) Regulations 2007.
I agree to the publication of my name (and the company name and contact details) in the environmental register.
I confirm that the information given in this application is true and complete to the best of my/our knowledge and belief.
I have not been convicted of any criminal offence in any country, other than motoring or minor offence resulting in a fine of less than $xxx. (or provide details)
I have read and agree to comply with the EIA consultants code of conduct. I will not reproduce the contents of any EIA report prepared by me as a consultant except with the permission of the client and the Ministry of Local Government, Housing and Environment.
I understand that the giving of false answers in this application may provide grounds for the withdrawal of registration as a consultant.
I have no objection to the Ministry making copies of this form available to other governmental or inter-governmental organisations.
Signed
Witnessed
Date
Company name (if any)
3 copies of this form duly completed must be sent to—
The Director
Ministry of Local Government, Housing and Environment
PO Box 2131
Government Buildings, Suva