Ref. No.		
About this Application	
Is this a NEW authorisation request?		…. OR  	an authorisation RENEWAL?		
	
Date approval requested by:		IF A RENEWAL, what is the previous Ref. No. for this application?			
	
Date renewal of access is due:			
	
About this person   refer to the Explanatory Notes on the reverse of this form
	
Person’s title:		Person’s full name:			
	
Position Title
(within the company):			
	
Phone Number:		Fax Number:			
	
Email address:			
	
Contact address:	

	
Security clearance details   refer to the Explanatory Notes on the reverse of this form
	
Reason authorisation is requested for the above person to access associated items:			
	
Current security clearance level:		Date issued:		Expiry date:			
	
Name of Vetting Agency:			

Applicant’s Signature	ASNO use only	
	Approved:	____/____/______

_______________________
for Director General ASNO	
Name :				
		
Position:				
Signature:	___________________________	Date:	____/____/__________		
	
Name of Permit Holder:		Permit number:			

Explanatory Notes

Ref. No.		A sequential reference number is required for each form of this type submitted by the Permit Holder (eg, 001, 002, 003, etc).  Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg, 003-Rev.1).	
Date approval requested by		
Access to associated items must not be granted prior to approval. Note that approvals are typically returned within 7 working days after submission of application	
Date renewal of access is due		
This date may not be later than one year after the date authorisation is requested for or the date clearance renewal is due, whichever is the sooner.	
Person’s full name		Must include all names, as they appear on your employment records, or on the previous authorisation approval.	
Contact Address		The address to which written notices can be sent.	
Applicant’s signature		
This form must only be signed by an individual authorised by the Permit Holder to provide this application, notification or report.	

This form replaces the following forms 	ASO122 (version 3 - issued 22 July 2010) and ASO123