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Are these details correct?
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Are these details correct?
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\nBSB: 037-866
\nAccount number: {{data.paymentReference}}
\nDescription: {{data.paymentDescription}}
Locked Bag 5005
\nWESTON CREEK ACT 2611
GPO Box 158
\nCanberra City, ACT 2601
{{data.agencyName}}
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\nABN: 88 407 290 295
The address we have for {{data.licenceName}} is:
\n\n{{data.applicantFirstline}}
\n{{data.applicantSuburb}} {{data.applicantState}} {{data.applicantPostcode}}
Is this address correct?
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\n\nIs this correct?
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\n\nIs this correct?
\n", "label": "On the records for your current licence, you hold a relevant professional registration and your professional registration number is.\n\nIs this correct?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes, this is correct and up-to-date.", "value": "Yes" }, { "label": "No", "value": "No" } ], "underHelpText": "" } }, "applicantEmail": { "htmlLabel": "Applicant Email", "label": "Applicant Email", "mandatoryMsg": "" }, "applicantEmployer": { "htmlLabel": "Applicant Employer", "label": "Applicant Employer", "mandatoryMsg": "" }, "applicantFirstline": { "htmlLabel": "Applicant Firstline", "label": "Applicant Firstline", "mandatoryMsg": "" }, "applicantMobile": { "htmlLabel": "Applicant Mobile", "label": "Applicant Mobile", "mandatoryMsg": "" }, "applicantName": { "htmlLabel": "Applicant Name", "label": "Applicant Name", "mandatoryMsg": "" }, "applicantPhoneCurrent": { "htmlLabel": "The phone numbers and email address we have for {{data.applicantName}} are:
\n\nPhone (business hours): {{data.applicantBHPhone}}
\nPhone (after hours): {{data.applicantAHPhone}}
\nMobile: {{data.applicantMobile}}
\nEmail: {{data.applicantEmail}}
Are these details correct?
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\n\n{{data.postalFirstline}}
\n{{data.postalSecondline}}
\n{{data.postalSuburb}} {{data.postalState}} {{data.postalPostcode}}
This is the address we will use for correspondence relating to this licence.
\n\nIs this address correct?
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GST is not applicable under section 81-5 of the A New Tax System (Goods and Services Tax) Act 1999.
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\n\nApplicant: {{data.applicantName}}
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\n\nPlease quote your reference code when enquiring about your submission.
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Phone: {{data.agencyPhone}}
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\n\nHealth and Community Services Directorate
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\n\nIf you do not have a current licence, you will need to complete a new licence application instead.
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\n\nIf you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.
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\n\nIf you continue to have difficulties, please contact the Health Protection Service on 02 5124 9700.
\n", "label": "Your licence details could not be loaded.\n\nPlease check your licence number and reapplication code and try again.\n\nIf you continue to have difficulties, please contact the Health Protection Service on 02 5124 9700.", "mandatoryMsg": "" }, "textDisplay_4": { "htmlLabel": "Please tell us why you no longer require this radiation licence: *", "label": "Please tell us why you no longer require this radiation licence: *", "mandatoryMsg": "" }, "textDisplay_5": { "htmlLabel": "The listed contact person is able to access licence details on behalf of the applicant, and may be contacted by the Health Protection Service from time to time if the applicant is unavailable.", "label": "The listed contact person is able to access licence details on behalf of the applicant, and may be contacted by the Health Protection Service from time to time if the applicant is unavailable.", "mandatoryMsg": "" }, "textDisplay_6": { "htmlLabel": "{{data.isCollab?\"\":\"When you saved your form you should have been provided a reference code.\"}}
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"", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "trackingCodeCustomPayment": { "htmlLabel": "Tracking Code Custom Payment", "label": "Tracking Code Custom Payment", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "trackingCodeCustom_2": { "htmlLabel": "", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "trackingCodeCustom_3": { "htmlLabel": "", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "unitSSB_2": { "htmlLabel": "Unit", "label": "Unit", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "unitSSB_3": { "htmlLabel": "Unit", "label": "Unit", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "unitvalue": { "htmlLabel": "UnitValue", "label": "UnitValue", "mandatoryMsg": "" }, "unitvalue_1": { "htmlLabel": "UnitValue", "label": "UnitValue", "mandatoryMsg": "" }, "updatedProfReg": { "htmlLabel": "Updated Prof Reg", "label": "Updated Prof Reg", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "westpacRestApiPayment": { "htmlLabel": "", "label": "Westpac REST API Payment", "mandatoryMsg": "", "properties": { "serviceName": "QW Form Handler", "trustedFrameOptions": "{\r\n \"showRequiredIndicators\": true, \"iframe\": {\r\n \"style\": {\r\n \"min-height\": \"424px\",\r\n \"width\": \"100%\",\r\n \"max-width\": \"400px\",\r\n \"padding\": \"8px\"\r\n }\r\n },\r\n \"showAcceptedCards\": false,\r\n \"labels\": {\r\n \"style\": {\r\n \"font-family\": \"\\\"Source Sans Pro\\\", sans-serif\",\r\n \"font-size\": \"18px\",\r\n \"line-height\": \"130%\",\r\n \"margin-top\": \"-4px\"\r\n }\r\n },\r\n \"cardholderName\": 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bank statement asACCESS CBR INTERNET PHILLIP", "mandatoryMsg": "" }, "yourSubmissionHasBeenSuccessful_3": { "htmlLabel": "Your submission has been successful. Please keep a copy of this receipt for your records.", "label": "Your submission has been successful. Please keep a copy of this receipt for your records.", "mandatoryMsg": "" } }, "label": "English" } ] }, "type": "form" }