MSIC Application Checklist

Your Issuing Body is: Veritas

Step 1: Review the details in Part A of your MSIC Application Form (page 3). If changes are required, please make the changes
on the form in pen and initial.
Step 2: Complete an Operational Need letter.
To be issued with an MSIC you must prove you have an Operational Need for a card. This means your job or business interests
require you to access a maritime security zone unmonitored at least once each year.
If your employer is registered with Veritas, they will be able to assist us to verify your Operational Need for an MSIC. Please contact
us if you are unsure whether your employer is registered with us.
If your employer is not registered with us, you will need to provide us with satisfactory evidence of an Operational Need for an MSIC.
This can be done by providing us a letter, signed by your employer, confirming your Operational Need.
A sample letter is on page 5.
Please ensure that you understand that it is an offence to retain an MSIC if you no longer need it (i.e. MSIC must be returned to the
Issuing Body within 30 days if your Operational Need no longer exists as per the MSIC Conditions of Use [Maritime Transport and
Offshore Facilities Security Regulations 2003, Section 6.08Q ])
Step 3: Gather your original identity (ID) documents. You will need to show:
One Primary ID document, and either
One Secondary ID document, or
Two Tertiary ID documents

Acceptable Forms of Identification:

Primary ID Documents
Birth Certificate (not an extract)
Australian Citizenship Certificate
Document from another country that is evidence that you are a citizen of that country
Passport (not cancelled or expired)
Secondary ID Documents (must be current ID)
Australian drivers licence
Other licence issued under a law of the Commonwealth of Australia or a state or territory (e.g. fisheries, firearms, etc.)
Commonwealth or a state or territory Govt. Employee ID
Australian tertiary Student ID
Verifiable reference that identifies your name and certifies that the person signing the reference has known you by the name listed
for at least 12 months and that the reference is signed by the applicant and referee. A verifiable reference means a reference
from:
a bank or similar financial institution; or
somebody whose identity has been verified by means of:
2 primary identification documents; or
a primary identification document and a secondary identification document; or
a primary identification document and 2 tertiary identification documents; or
a referee acceptable to the person or body that requires the identification of the identified person.
Tertiary ID Documents (must show your name and residential address and be less than 6 months old)
Signed statement from employer or former employer about that employment; or
Certified copy by Registrar of Titles or similar officer of a record issued under a law about land titles; or
Document issued by a rating authority from its records about land ownership or occupation; or
Document issued by a bank or similar financial institution from its records about a mortgage or other security that applicant gave to
bank or institution; or
Extract from electoral roll compiled by the Australian Electoral Commission; or
Record issued under a law in force in Australia other than a law about land titles.

Step 4: Lodge your Application

To complete your application, take your MSIC Application Form (pages 3 - 4), Operational Need letter (page 5), Passport Photo (see
information below) and original Identity Documents (see list on page 1, Step 3) to:
Option 1: In Person at Veritas
Perth CBD Office
Please call 1300 VERITAS (1300 837 482) or +61 8 9226 0711 to book an appointment.
Darwin Office
Please call +61 8 8930 3204 to book an appointment.
Option 2: Australia Post
Once completed, Australia Post will accept your application and forward it to us for processing. Please note that some forms of
identification may not be accepted by Australia Post for verification of identity. Please see Part D of the application form for a
complete listing. Go to http://auspost.com.au/pol/app/locate/post-office/maritime-security-identity-card to find the Post Office
nearest you.

Passport Photo Information

Passport photos will be taken free of charge when lodging at our Perth CBD or Darwin office. Passport photos can be taken at
Australia Post but you will bear the cost of this photo.
Photograph must be recent (that is, taken within 6 months)
Photograph shows holders full face and his or her head and shoulders

Additional Notes:
1. Authentication of certain foreign documents. Veritas may require an applicant to have the authenticity of a proof of identification
document authenticated by the government that issued the document.
2. Entitlement to work. You must provide a document that shows you are an Australian citizen (e.g. your Australian birth certificate,
Australian Passport, or Australian naturalisation certificate); or you must satisfy us (the issuing body) that you hold a current visa
entitling you to work in Australia.

Veritas
General Enquiries
1300 VERITAS (1300 837 482) or +61 8 9226 0711
Office Hours: Monday - Friday, 9:00am - 5:00pm (AWST)

www.msic.net.au
msic@veritasgroup.com.au
Fax: +61 8 6323 0425

Perth CBD, WA - Head Office

67 Milligan Street
Perth, Western Australia 6000

Darwin, NT
Unit 7, 42 Toupein Road
Yarrawonga, NT 0830

Perth Appointments
1300 VERITAS (1300 837 482) or +61 8 9226 0711
Monday - Friday, 10:00am - 4:00pm (AWST)

Darwin Appointments
+61 8 8930 3204
Monday - Friday, 10:00am - 2:00pm (ACST)

If lodging at the Perth or Darwin office, please call to book an appointment. Outside of these hours, please call us to discuss or
continue to lodge your application at any one of over 4,000 Australia Post retail outlets nationwide.

Application Identification Number

MSIC Application

VEP0092312

www.msic.net.au

Department of Infrastructure and Regional Developm

Instructions:
1. Please review the details in Part A of this application. If changes are required, make the changes on the form in pen and initial.
2. Take this form, your identity documents and Operational Need letter to Veritas or your Australia Post outlet to have your verification of
identity check completed and to submit your forms. Photos can be taken if lodging at Veritas. Passport type photos required if lodging at
Australia Post.
3. Approved applicants will typically receive their MSICs in 1 - 2 weeks however times do vary.
For queries, contact Veritas on 1300 VERITAS (1300 837 482) or +61 8 9226 0711.

Part A: Applicant Information

Application Type:
Standard MSIC 2 Year expiry 4 Year expiry
The 4 year option includes a second background check
at the end of 2 years.

Provisional MSIC
Tick this box if you are under 18 years of age. When you turn 18 you
must apply for a Standard MSIC.
MSIC based on your ASIC
Your MSIC will expire on the same date as your ASIC.
Current ASIC Number:

Previous MSIC Number (if applicable):

Personal Details

Contact Details

Surname (Present):
Given Names:
Date of Birth:

Caldes Casas
Javier
16 Sep 1968

Home Phone:
Work Phone:
Mobile:
Email:

0435449979
javier.caldescasas@infrastructure.gov.au

Home Address

Postal Address

24 Mitchell str
Darwin, NT, 0800
Australia

24 Mitchell str
Darwin, NT, 0800
Australia

Part B: Declaration of Operational Need (sign in presence of agent conducting verification of identity)
I understand that I am applying for a Maritime Security Identification Card. The information I have provided in this application is correct to the best
of my knowledge. I understand that my personal information will be used by AusCheck to coordinate a background check through the Australian
Security Intelligence Organisation, CrimTrac and the Department of Immigration and Border Protection, where necessary. I may request from my
Issuing Body or access via the AusCheck website, a copy of the brochure, AusCheck Privacy Notice, which explains how AusCheck will use my
personal information.
Statement of Operational Need: I acknowledge that I have an Operational Need to hold an MSIC as my occupation or business interests
require, or will require, me to have unmonitored access to a maritime security zone at least once each year (in accordance with the
Maritime Transport and Offshore Facilities Security Regulations 2003, Section 6.07F.
Sign:

Date:

Part C: Payment Details

TAX INVOICE
Veritas Engineering Pty Ltd 57 107 945 988

Lodge completed application at

Veritas' Perth CBD or Darwin
office OR at any Australia Post
nationwide.

Option 1: In person at Veritas

Present completed application at our Perth CBD or
Darwin office:
Perth CBD Office
67 Milligan Street, Perth, Western Australia 6000
Darwin Office
Unit 7, 42 Toupein Road, Yarrawonga, NT 0830

Employer Sponsored: No Payment Collected - $0.00

Cheques made payable to "Veritas Engineering"
EFT Payments to: BSB 016-359 Acct: 4948-92079
Ref: VEP0092312

Option 2: Lodge at Australia Post

Present completed application in person at any Australia Post nationwide displaying Bank@Post signage.
Cash, Cheque, EFTPOS, Credit Card (VISA, MasterCard) accepted.
Employer Sponsored:
Validity based upon Employer
Sponsored Payment. No Payment
Collected - $0.00

Part D: Verification of Identity (Issuing Body Representative or Australia Post Use Only)
Verification of Identity: Applicant must prove their identity by showing one primary identification document and either:
a. One secondary identification document; or
b. Two tertiary identification documents.
Applicants may verify their identity at either an Australia Post outlet or by a Veritas representative. Please check the list below to confirm which types of documents are accepted as
proof of identity by each agency.
Accepted at
Primary Identification Documents

AusPost Veritas Documents (Tick when presented)

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

A certified copy (that is, a copy certified by a Registrar of Births or similar

officer to be a correct copy) of the entry, in a register of births, of his or her
birth (not an extract); or
A copy (certified under section 44 of the Australian Citizenship Act 1948) of
an Australian citizenship certificate granted to him or her; or
A document issued to him or her under the law of another country that is
evidence, under that law, that he or she is a citizen of that country; or

Reference (Complete if ticked)

Ref No.:
Date of Issue:

Ref No.:

Date of Issue:

Ref No.:

Date of Issue:

Place of Issue:

Type:
Country:
Country:

A passport issued to him or her (must not be cancelled or expired).

Ref No.:
Date of Issue:
If a foreign passport is presented, applicant holds a visa entitling him or her
to work in Australia.
Visa number: _______________ Expiry Date: _________
Secondary Identification Documents (Must include photograph OR signature of applicant AND must be current ID)
Yes
Yes
A licence (for example, a drivers licence) issued to him or her under a law
Ref No.:
Date of Expiry:
State:
of the Commonwealth of Australia or a State or Territory; or
Yes
Yes
Commonwealth, State or Territory Government Employee ID issued to him
Ref No.:
Date of Issue:
Organisation:
or her; or
Yes
Yes
An Australian tertiary student identification document issued to him or her;
Ref No.:
Date of Issue:
Organisation:
or
No
Yes
A verifiable reference that identifies the applicant by name and certifies that
Details of referee:
the person who signs the reference has known the applicant by that name
Name of Bank: __________________________________
for at least 12 months, and the reference is signed by the applicant and the
Branch: _____________________
referee. A verifiable ref. about somebody (the identified person) means a
or
reference from:
Types of verification of referee (list types and details as above):
a. a bank or similar financial institution; or
b. somebody whose identity has been verified by means of:
1. ____________________________________________________________
i. 2 primary identification documents; or
2. ____________________________________________________________
ii. a primary identification document and a secondary
identification document; or
iii. a primary identification document and 2 tertiary identification 3. ____________________________________________________________
documents; or
c. a referee acceptable to the person or body that requires the
identification of the identified person.

4. ____________________________________________________________

Attach photocopy of reference

Tertiary Identification Documents (Must include name AND residential address of applicant AND be less than 6 months old)
No
Yes
Signed statement from employer or former employer about that
Attach a photocopy of reference
employment; or
Yes
Yes
Certified copy by Registrar of Titles or similar officer of a record issued
Ref No.:
Date of
under a law about land titles; or
Yes
Yes
Document issued by a rating authority from its records about land
Ref No.:
Date of
ownership or occupation; or
Yes
Yes
Document issued by a bank or similar financial institution from its records
Ref No.:
Date of
about a mortgage or other security that applicant gave to bank or institution;
or
Yes
Yes
Extract from electoral roll compiled by the Australian Electoral Commission; Ref No.:
Date of
or
No
Yes
Record issued under a law in force in Australia other than a law about land
Ref No.:
Date of
titles.
Interviewer's Declaration
I declare that the attached photograph is a true likeness of the applicant. I have conducted an interview and confirmed the
information provided in this application for an MSIC against original documentation submitted.

Issue:

Type:

Issue:

Type:

Issue:

Type:

Issue:
Issue:

Type:

Signature of Interviewer:
Printed Name:
Date Signed:

Part E: Entitlement to Work (Issuing Body Use Only)

Evidence presenting indicating that the applicant is an Australian citizen e.g. his or her Australian birth certificate, Australian Passport, or Australian naturalisation certificate; or
The issuing body is satisfied that he or she holds a visa entitling him or her to work in Australia
Part F: Operational Need (Issuing Body Use Only)
Applicant provides evidence that he or she has an Operational Need (e.g. letter from employer); or
Applicants employer confirms applicants Operational Need.
Part G: Card Issue (Issuing Body Use Only)
MSIC Card Number: V E P / ___ ___ ___ ___ ___ ___ ___
Collected by (Applicant)
Signed:
Print:
Date:

Employer:

Emp. Contact No.:

Type:

Statement of Operational Need for a

Maritime Security Identification Card (MSIC)
Section 6.08B of the Maritime Transport and Offshore Facilities Security Regulations 2003 states that "a person may, in
writing, apply to an issuing body for an MSIC".
Employers or designated facility operators may complete this letter on behalf of their employees, contractors, or other
authorized persons to serve as documentary evidence of the listed applicants' Operational Need to possess an MSIC.
An application for an MSIC will not proceed until a signed Statement of Operational Need is received for each applicant.
Signed statements should be posted or scanned and emailed to:
Veritas Engineering Pty Ltd, PO Box 7696, Cloisters Square, Western Australia 6850 or msic@veritasgroup.com.au

Date: _____________________________________
Dear Veritas Engineering (MSIC Issuing Body),
I acknowledge that a person has an Operational Need to hold an MSIC if his or her occupation or business interests require, or will require,
him or her to have unmonitored access to a maritime security zone at least once each year (in accordance with the Maritime Transport and
Offshore Facilities Security Regulations 2003, Section 6.07F).
I confirm that the following individual(s) has/have an Operational Need for an MSIC:
First, Middle, Last

Date of Birth

The above named individual(s) also understand that it is an offence to retain their MSIC if they no longer possess an Operational
Need for it (i.e. MSIC must be returned to the Issuing Body within 30 days if their operational need no longer exists as per
Conditions of Use [Section 6.08Q]).
Name:

Position:

Signed:
Organisation:

ABN:

Address:
Contact Number:

Email:

Payment Details
Applicant to pay
Company to pay. Business unit / project (if applicable) ________________________________
Purchase order number or cost code ________________________________
Select if MUST be:

2 years or

4 years or

Applicant to select