Guardian Service Centre Information Form

Step 1 of 2

Registered Company Name *

Business Name *

Type of Company *

eg. Sole Trader, Company, Partnership

ABN and ACN *

ACN (only if applicable)

State Workshop Approval Number *

Please upload approval to File Upload section

Registered for GST *

Business Address *

Address Line 1

City

State / Province / Region

Postal Code

Postal Address *

Address Line 1

City

State / Province / Region

Postal Code

Email *

Workshop Phone *

Applicant's Mobile Phone

Workshop Fax (if applicable)

Bank / Branch *

Bank Address *

BSB / Account Number *

Length of time since Establishment of Business *

Hourly rate (what is your current standard hourly rate?) *

Are you Auto Electricians ? *

Do you belong to the Bosch Dealer Network ? *

Documentation to attach

Workers Compensation Insurance Certificate of Currency
Public Liability Insurance Certificate of Currency (NSW/WA – $5 million, SA/NT/QLD – $10 million, ACT/TAS/VIC – $20 million)
State Workshop Approval Certificate

File Upload – load above attachments and any other documentation you wish to provide here *

Click or drag files to this area to upload. You can upload up to 10 files.

If you are uploading a photo from your phone please ensure the photo is not in LIVE photo mode.

If accepted as an Approved Service Centre, does your business have the following facilities:

A spare telephone line that can be used for EFT etc? *

Internet Access on site *

Internet Provider details *

Do you have Static IP address ? *

Scanner / photocopier *

Printer that could be connected to a Guardian PC *

If Yes, Printer Make and Model (ie. Brother TN2030)

Do you have any Mobile facilities ? *

Please provide details

What security measures do you have in place ? *

eg. back to base alarm

Relevant Qualifications and Experience

Number of staff at Service Centre *

Number of qualified Auto Electricians at Service Centre *

Electrical Trade Certificate III (or state equivalent) in Automotive and Professional Experience *

Names of Staff seeking approval as Installers and / or Service Providers *

Please note that upon approval, all staff will need to provide a valid Police Check prior to training.

Have you ever been approved as an interlock Installer or Service Provider within Australia ? *

Have you been convicted of a relevant offence in the last five years, are you an undischarged bankrupt or have you ever had an interlock driver licence suspected or cancelled ? *

Applicant's declaration

I declare that the information I have have given in this application is true and correct and I agree to comply with these requirements

I acknowledge that submission of this application does not guarantee approval as an Interlock Installer or Service Provider. I understand that my personal information is being collected and held by Guardian Interlock Systems, 8/11 Packard Ave, Castle Hill NSW 2154. I have a right to access or correct my personal information in accordance with the provisions of the relevant privacy legislation. The information supplied may be disclosed in accordance with the exemptions provided in the Privacy and Personal Information Protection Act 1998.

Applicant Name *

First

Last

Position *

Date *