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Online Form - Applicaton for Monumental Masons Licence

Applicant Details

Title
Have you ever been convicted of any offence, anywhere?

By typing your name in the below box, you certify that:

  1. I will comply with the Laws of the State of Western Australia, including the Cemeteries Act 1986, the Town of Port Hedland Local Laws, and any policies, procedures and guidelines the Town may issue from time to time, including compliance with those standard contained within the Australian Standard as4204-1994 Headstones and Cemeteries Monuments, as the Town may adopt from time to time.
  2. I acknowledge and accept that the erection of all monumental work will be carried out by a qualified monumental mason employed by the above company.
  3. Where another monumental mason is sub-contracted to perform work on behalf of the above company, that the person must be licensed as a monumental mason by the Town and produce their certificate of currency of third party insurance.
  4. No monuments will be erected prior to the approval of the Town being obtained.
  5. I will make separate application for each gravesite and will attach a carefully drawn plan of the proposed memorial along with all specifications, fully dimensional and a list of all proposed materials, which will be used. All ornaments etc to be shown and dimensioned.
  6. I agree to maintain the currency of my Third Party Insurance and Workers Compensation Insurance (where applicable) as a condition of my licence.
  7. I have never been declared bankrupt or placed into receivership.
  8. I understand and acknowledge that the Town can refuse to issue licence, or cancel or suspend a licence at any time.

Insurance Details


Please note

If more than one place of business is to be utilized, then provide details of those locations and their respective address, contact person, telephone, facsimile, email etc on a separate document to this application and attach it below.


Insurance Certificates

A copy of your Certificate Of Currency Of Third Party Insurance And Workers Compensation Insurance must be submitted with this application. Please attach it below.