Ref. No.		
Period of effect	
	
Proposed period of effect:	Start date:		Finish date:			
	
Subcontractor’s details-  refer to the Explanatory Notes on the reverse of this form	
	
Subcontractor’s name:			
	
Address:			
	
Phone number:		Mobile:		Fax number:			
	
Email address:			
	
About the contract
	
List the Permit function(s) being subcontracted:			
	
Specify the permit conditions for which the subcontractor will carry responsibility:	

		
	
Describe how the Permit Holder will ensure the above permit conditions are fully implemented:	

		
	
Checklist – tick applicable boxes

(a)	The subcontractor is aware of the restrictions and conditions of the Permit relevant to the subcontractor’s work:	
(b)	The contract includes a signed confidentiality agreement	
(c)	The contractor has/will undertake security awareness training.	
(d)	The contract includes performance indicators	

	YES 	NO 	N/A 

	YES 	NO 	N/A 

	YES 	NO 	N/A 

	YES 	NO 	N/A 

Applicant’s signature, and permit details	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 2005-003 Rev 1)	
Start date		The contract must not commence prior to approval being granted. Note that approvals are typically returned within 14 working days after receipt of the application.	
Subcontractor’s details		
Provide additional documentation if space on the form is insufficient.	
Applicant’s Signature		
This form must be signed by a representative of the Permit Holder (i.e. the organisation) who will take responsibility and sign documents on behalf of the organisation.	

This form replaces the following form 	ASO135 (version 1 – issued 27 March 2008)