Application for Authorisation of an Explosive
This form is used to apply for a new or the amendment to an existing
authorisation for explosives in accordance with Regulation 82 of the
Dangerous Goods Regulations.
TBC Use Only
Date Received:
Fee Received: $
Type of Application
New
Receipt No:
Reciprocal
Amendment
Received by (TBC staff Name):
(no charge)
Application Fee:
Please refer to Licensing Fees and Charges bulletin for current fees and charges.
Application for Authorisation of an Explosive
1. Current Authorisation Number (amendment only)
Authorisation Number:
2. Applicant Details
Business Name:
ABN:
Trading Name:
Name of applicant:
Postal Address:
Suburb:
State:
Work Number:
Mobile Number:
Fax Number:
Email Address:
Postcode:
3. Explosive Type
Authorised name of explosive:
Correct shipping name:
Class:
UN No:
Product No:
Proof of classification:
Type of explosive:
If detonator, list type:
Primary use:
Mean of initiation:
Manufacture:
Locations:
4. Explosive formulation of characteristics
Net explosive quantity:
Characteristics
Density:
+
G/cc
RWS:
VOD:
Viscosity:
Chemical Composition – Content and tolerance
Raw Material Name
Content
Total
+/-
Application for Authorisation of an Explosive
5. Packaging (photos to be attached)
Box construction:
Package approval no:
Box dimensions:
Contents:
Box gross weight (kg)
6. Labelling
Outer package
Size of print
Shown yes/no
Correct shipping name:
Lot/batch number:
Authorised name:
Name/Australian address:
UN number:
Date of manufacture:
Class label:
Package approval number:
Subsidiary label:
Other markings:
Word “explosive”:
Inner package
Authorised name:
Nature of packaging:
Class label:
Explosive:
Other markings:
Name and address:
7. Safety
Shell life (months):
Potential hazards:
Nature of deterioration:
Method of disposal:
Special precautions in use (Refer to attached Technical Data Sheet number):
Is an SDS available? SDS number:
Is one attached?
Yes
No
Is an EPG available or type of EPG used?
Is one attached?
Yes
No
Yes
No
Any other relevant information?
8. Authorisations
Has the explosive been authorised elsewhere in Australia? (If yes, complete below)
Which jurisdiction has it been authorised in?
NT
WA
ACT
NSW
QLD
SA
VIC
TAS
Department of Defence
Yes
No
Other? (please provide details below)
Yes
No
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Application for Authorisation of an Explosive (V2 – February 2015)
Application for Authorisation of an Explosive
PLEASE NOTE: COPIES OF AUTHORISATION APPROVAL LETTER FROM A RECOGNISED
AUSTRALIAN JURISDICTION’ ARE TO BE PROVIDED WITH THE APPLICATION
9. Declaration
I do solemnly declare that the information in this application is true and correct to the best of my knowledge.
I agree that information contained in this application may be disclosed on a confidential basis to other competent
authorities in explosives in Australia at their request
Name of person supplying details:
Position title:
Telephone number:
Email address:
I agree that the information contained in this application may be disclosed to other authorities in explosives at their
request.
Signature of Applicant:
Date:
Checklist
Application form is complete
A copy of the interstate authorisation/amendment letter is attached
The Safety Data Sheet (SDS) is attached – Dangerous Good Regulation 82(2)
The Technical Data Sheet and photos are attached – Dangerous Good Regulation 82(2)
Photos of the packaging/product are attached
The Emergency Procedure Guide for Transportation is attached. – Australian Explosive Code section 8.3.7
Payment of application fee
Privacy
The Department of Business complies with the Information Privacy Principles scheduled to the Information Act.
Lodgement
Incomplete applications cannot be processed and will be returned. Complete applications, together with payment and all
supporting documents can be lodged at the Territory Business Centre either in person, post or email.
Territory Business Centre – Contact Details
Darwin
Katherine
Tennant Creek
Alice Springs
Ground Floor,
Development House.
Shop 1, Randazzo Building.
Shop 2, Barkly House
18 Katherine Terrace.
Cnr Davidson and Patterson
Street.
Ground Floor, The Green
Well Building.
76 The Esplanade
Phone: 1800 193 111
50 Bath Street
Email: territory.businesscentre@nt.gov.au
Postal: GPO Box 9800, Darwin, NT 0800
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Application for Authorisation of an Explosive (V2 – February 2015)
Application for Authorisation of an Explosive
Payment Details
Payment Method
Cash - Territory Business Centre
Cheque - payable to RTM (Receiver to Territory Money)
Credit Card
Visa
MasterCard
Credit Card number
Expiry
Name on card
I hereby authorise the Territory Business Centre to debit the above credit card for the amount of
Signature of cardholder
$
Date
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Application for Authorisation of an Explosive (V2 – February 2015)