SECTION 11(2), 15(2), 16(2)
NORTHERN TERRITORY OF AUSTRALIA VETERINARIANS ACT
Application for new registration as a veterinarian
* Mandatory Registration
Requested Primary
Surname: * Given names: *
NT postal address: *
For serving notices
Professional/Practice Address: *
If no NT practice is advised then the board will not proceed with your registration
NT practice: *
Work telephone: * Email Address: *
Qualifications: *
University where you gained your initial Veterinary qualification / degree
Name of qualification / degree
Year of qualification / degree Date of birth: *
Have you previously been registered, and are you now registered, in any other
Australian State or Territory, or in a place outside Australia? * Yes
If YES, please give details and provide a Letter of Good Standing from your current registering body if you are registering as a Primary registrant in the NT.
State / Territory / Place Years Currently Registered
Do you intend to practise in the Northern Territory in the next 12 months? * Yes Commencement date:
Area of practice: * (e.g. small animal)
Application for New Registration as a Veterinarian
Veterinary Board of the Northern Territory Page 2 of 4
YES NO
If you answer YES to any of the below questions please provide details, in the space below (if more space is required attach a separate sheet)
Is your registration in another Australian State/Territory or another place subject to limitations?
Have you ever had an application for registration refused?
Has your registration ever been cancelled or suspended?
Have you ever been reprimanded or cautioned under a law relating to the provision of veterinary services or had conditions placed on your registration?
Are you now under investigation under a law relating to the provision of veterinary services?
Have you ever been convicted of any criminal offence?
Have you ever been convicted of any offence relating to:
Laws dealing with the provision of veterinary services?
Laws relating to the regulation of poisons, drugs or similar substances?
Laws relating to the welfare or the prevention of cruelty to animals?
Have any claims for damages or compensation in relation to negligence or other misconduct in the provision of veterinary services been made against in the last two years?
Do you object to the Veterinary Board of the Northern Territory making inquiries of, and exchanging information with, the registration authorities of any
State/Territory or other country regarding your activities as a veterinarian, and other matters relevant to this application?
Application for New Registration as a Veterinarian
Veterinary Board of the Northern Territory Page 3 of 4
NORTHERN TERRITORY OF AUSTRALIA Oaths, Affidavits and Declarations Act STATUTORY DECLARATION
I, (Name in Full)
of do solemnly and sincerely declare that (1) the details provided in this Application for Registration as a Veterinarian are true in every particular to the best of my knowledge and belief; (2) I make this solemn declaration by virtue of the Northern Territory Oaths Affidavits and Declarations Act 2010; and (3) I understand that it is an offence to make a statutory declaration that is false in any material particular.
Declared at the day of 20
Signature of person making declaration Before me
Signature of Witness Name
Contact address Telephone
Before whom the declaration is made.
This Declaration may be made before any person who has attained the age of eighteen years. Under section 119 of the Northern Territory Criminal Code, a person who wilfully makes a false statement in a statutory declaration is guilty of a crime and is liable to imprisonment for three years.
Submission of application form:
This form , together with any required documentation and fees should be forwarded to:
The Registrar
Veterinary Board of the Northern Territory GPO Box 3000
DARWIN NT 0801 AUSTRALIA
Enquiries: Phone (08) 89992028 - Fax: (08) 89992089 - Email: [email protected] You must attach:
1. A certified copy of your initial qualification (unless you are currently registered in another State/Territory of Australia, in which case this would not be required).
2. A Letter of Good Standing from the most recent Board that you have been registered with, or if you are a new graduate and have not been registered elsewhere, certification from your University giving details of the degree to which you have been admitted, the date of admission, stating that you are of good character.
3. The prescribed fee(s) – view the current fees on the Veterinary Board website - https://industry.nt.gov.au/boards-and-committees/vetboardnt/fees
Note: It is an offence for a person to provide a veterinary service unless the person is a registered veterinarian.
Penalty: 500 penalty units.
Application for New Registration as a Veterinarian
Veterinary Board of the Northern Territory Page 4 of 4
Privacy and use of information
The Veterinary Board of the Northern Territory, under the Veterinarians Act and the principles of mutual recognition legislation, collects the information on this form, or otherwise provided by you, to process your application for registration.
Failure to provide the information in full or in part may result in your application for registration being refused. Some of the personal information provided by you will be made publicly available through the internet, as part of a Public Register published on the Veterinary Board website.
The fields of information published are limited to Registration Number, Name, Date of First Registration, Veterinary Qualifications, Area/Field of Practice, Category of Registration (ie Primary for majority practice in the NT or Secondary for locum/periodic practice in the NT), Professional/Practice Address, and
Telephone Contact Number (with the veterinarian’s consent).
Any personal information provided can be subsequently accessed by you on request. Registered
veterinarians are encouraged to check the accuracy and currency of the details listed in their entries in the Public Register on the Veterinary Board website and to advise the Board of any changes required. The link is: https://industry.nt.gov.au/boards-and-committees/vetboardnt/veterinary-register
Notes regarding qualifications and registration categories
Full Registration (ie registration without limitations/conditions) is only available to:
• Graduates in veterinary science from the Universities of Melbourne, Sydney, Queensland, Murdoch, Charles Sturt, James Cook, University of Adelaide and Massey University (Postgraduate
qualifications are not acceptable).
• Persons holding qualifications approved by the Veterinary Schools Accreditation Advisory Committee;
or accredited for
• membership of the Royal College of Veterinary Surgeons (including by examination); or accredited by the American Veterinary Medical Association, with a pass in the North American Veterinary Licensing Examination.
• Persons who have successfully completed the Australian National Veterinary Examination (AVE).
• Persons who have full registration (ie registration without limitations/conditions in another State of Australia, or New Zealand.
Limited Registration may be granted to persons who have limited registration in another Australian State, or veterinarians who wish to undertake locum work in the Northern Territory for brief periods.
Commencement date must be given.
Primary Registration - Veterinarians whose majority practice is in the NT are recorded in the Veterinary Register as having "primary" registration.
End of form
