Membership Form

MEMBERSHIP APPLICATION/RENEWAL

Australian Institute of Private Detectives

ACN 054 902 000 ABN 28 054 902 000

PO Box 276 FRENCHS FOREST NSW 2086 AUSTRALIA

Ph: (61 2) 9975 6430 Fax: (61 2) 9975 2147

PLEASE SELECT ONE OF THE BOXES BELOW:

New Members		I hereby apply for membership of the Australian Institute of Private Detectives Limited as a
Existing Members	Member #:
		I wish to renew my current membership.
		I wish to change/update my current membership details.

APPLICANT’S/MEMBER'S PERSONAL DETAILS:

Surname:		DOB (dd/mm/yyyy):	//
First Name:		Initial/s:
Residential Address:
Suburb:	State: P/Code:
Country:
Contact #�s:	Ph: ( ) Fax: () Mob:

Business Name:
Business Address:

Suburb:	State: P/Code:
Contact #�s:	Ph: ( ) Fax: () Mob:

Postal Address:
Suburb:	State: P/Code:

DX Address:	DX #: DX Suburb:

Email Address:
Website Address:

APPLICANT’S/MEMBER'S LICENCE DETAILS:

1.
Licence type:
2.
Licence type:

Licence #: Licence #:

Renewal date: // Renewal date: //

Issued at: Issued at:

Years held: years months Years held: years months

CLASSIFICATIONS:

A	Arson	FL	Family Law	PI	Public Investigator
CB	Criminal Briefs	Fr	Fraud	PL	Public Liability
CC	Criminal Consultant	HIF	Health Insurance Fraud	PS	Process Serving
CL	Criminal Law	I	Investigations	Rep	Repossessions
CrB	Credit Bureau	IC	Income Protection	RM	Risk Management
CTP	Compulsory Third Party	In	Insurance	S	Surveillance
D	Defamation	IP	Intellectual Property	Sear	Searches
DA	Debtor Assessment	LA	Loss Assessing	Sec	Security
DB	Debug	LD	Locate Debtors	SMV	Stolen Motor Vehicle
DDT	Dust Disease Tribunal	LMP	Locate Missing Persons	TI	Tax Investigations
DI	Domestic Investigations	LS	Legal Searcher	U	Undercover
DR	Debt Recovery	M	Medical	WC	Workers Compensation
DT	Dog Training	Mp	Malpractice
F	Factual	MVA	Motor Vehicle Accident Scene Investigation

I hereby solemnly and sincerely declare that all of the above details are true and correct in every particular and that I shall abide by the Memorandum and Articles of Association of the Code of Ethics of the Institute.

Signed:

__________________________________

Dated (dd/mm/yyyy): //

MEMBERSHIP FEES

A fee of A$300.00 applies to BOTH New Membership Applications and Annual Membership Renewals. Acceptance of applications/renewals is subject to clearance of payments received in full.

Cheques/money orders should be made payable to AIPD and forwarded with Membership Application/Renewal forms to the above address.

Credit Card payments may be posted, faxed or phoned to the address/numbers shown above.

Please indicate payment method

Credit Card Payments: Card Holder Details

Card Type:
Card #:		Expiry Date: /
Cardholder's Full Name:
Address:
Suburb:	State: P/Code:
Amount Payable:	A$300.00
Cardholders Signature:	__________________________________	Dated: //

1.	Licence type:		2.	Licence type:
	Licence #:			Licence #:
	Renewal date:	//		Renewal date:	//
	Issued at:			Issued at:
	Years held:	years months		Years held:	years months