Creator'S Registration
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Creator’s Registration
Claimant number
Public Lending Right (PLR)
Educational Lending Right (ELR)
Please use BLOCK LETTERS and read the instructions on page 2 before you complete this form
1. Your details
Title
Given name(s)
Family name
Year of birth
Occupation
Address
State
Postcode
Phone
BH (
)
Mobile
Fax
(
)
AH (
)
Email
Work
Home
2. Citizenship status
Are you an Australian citizen?
Yes
No
Do you normally reside in Australia?
Yes
No
3. Goods and Services Tax (GST)
Payments made under the Public and Educational Lending Rights programs (PLR and ELR) are not subject to GST.
Claimant ABN details or other information in relation to taxation status are not required for this application.
Note: Claimants need to declare PLR and ELR payments for income tax purposes.
4. Lending Rights payments are
Name of bank or
made by direct credit
fi nancial institution
Branch
Branch number (BSB)
Must be 6 digits
Account number
(Max 9 digits)
Account name
5. F reedom of Information
Under the Freedom of Information Act claimants may seek exemption from disclosure of information about
their payments. However the PLR Committee reserves the right to include names of claimants and books in its
Annual Report provided that the inclusion of such information does not identify the actual payments received
by the claimant or the relative ranking of the claimant.
6. C reator’s background
Please indicate if you identify as belonging to either of these groups. This infomation will only be used for
general statistical purposes and individuals will not be identifi ed.
Aboriginal/Torres Strait Islander
Non-English speaking background
By submitting this form, you are agreeing to the following statements
:
7. Declaration
• I declare that the information I have supplied is true and correct.
• I understand that making false and misleading statements in applications, and the provision of false or misleading
information constitute offences under Sections 136.1 and 137.1 of the Criminal Code 1995, and that these offences
carry serious penalties.
• I acknowledge that the Public Lending Right (PLR) Committee may at any time require me to provide information,
documents or verifi cation of information.
• I consent to the disclosure of information provided by this claim, and any other information provided for the purposes
of this claim, to the PLR Committee for the purpose of making recommendations to the Minister for the Arts
or his delegate concerning payments that may be made under PLR and/or ELR.
• If I am unable to be located to receive Lending Rights correspondence or a payment, my name and the suburb/city/state
of my last known address may be published on the Lending Rights website.
dd/mm/yyyy
Date
Signature
/
/
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