APPLICATION FOR ISSUE OF A
QUALITY ASSURED ASSESSMENT MATERIALS
TRADE MARK
Instructions
 Please read the Regulations for the Quality Assured Assessment Materials
trade mark (QAAM) before completing this application, see:
www.nzqa.govt.nz/qaam
 This form may be completed manually and posted or sent electronically
with attachments to: accountsreceivable@nzqa.govt.nz.
SECTION 1: Applicant details
Name of Organisation / Applicant
Contact person (Surname / First name)
Postal address
Postcode
E-mail address for contact
Daytime phone numbers
I enclose payment of $960+GST per assessment activity
Number of Applications attached
Signature:
Date:
SECTION 2: Method of Payment
Cheque - made
payable to NZQA
Visa
MasterCard
Direct Debit- please contact NZQA at
above email address for details prior to
payment by this method.
Card Account number
Cardholder’s Signature
Expiry date
Name on card (please print)
Please complete and return to Finance, New Zealand Qualifications Authority
PO Box 160, WELLINGTON 6140
Email: accountsreceivable@nzqa.govt.nz
SECTION 3: Assessment Activity details
Name of Assessment Activity #1
Standard Number
New application
Version Number
Resubmission
Subject
Deficiency remedy request
Previous QAAM trade mark number (if held)
Q
A
2
0
Name of Assessment Activity #2
Standard Number
New application
Version Number
Resubmission
Subject
Deficiency remedy request
Previous QAAM trade mark number (if held)
Q
A
2
0
Name of Assessment Activity #3
Standard Number
New application
Version Number
Resubmission
Subject
Deficiency remedy request
Previous QAAM trade mark number (if held)
Q
A
2
0
Name of Assessment Activity #4
Standard Number
New application
Version Number
Resubmission
Previous QAAM trade mark number (if held)
Q
A
2
0
Subject
Deficiency remedy request
SECTION 4: NZQA use only
Date received
Date sent to moderator
Date payment receipted
Date return by moderator
All materials enclosed
Yes / No
QAAM #1
Application number
QAAM #2
Request for other date
QAAM #3
Rejection sent date
QAAM #4
Application result date
Date databases updated
SECTION 5: NZQA use only
Item Code
RC
$
Date