Pre-registration Form

I am a:
 

Business owner’s name:
 

Business name:
 

Number of FTE workers:
 

ABN:
 

Business address:

State:

Postcode:
 

Postal address:

State:

Postcode:
 

Daytime contact number:
 

Mobile number:
 

Email:
 

Is farming the main activity of this business?
 

Total rebate that you intend to apply for:
 

Please provide a breakdown of the rebate that you are applying for:

 
Eligible safety solutions
Quantity
Training

Helmets

OPDs

Side by side vehicles

  
I understand that pre-registration only holds fund for 60 days to allow applicants the opportunity to attend an eligible educative interaction, purchase eligible rebated items and submit application forms. If I fail to submit my completed application within 60 days, the fund will be “unfrozen” and returned to the remaining pool of funds.  


 

SafeWorkNSW 

The NSW Quad Bike Safety Improvement Program is funded by SafeWork NSW.

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