MBA ACT Membership Application Form

Applicant Details

Business Type *CompanySole TraderPartnership

Applicant/Business Name *

Trading Name (if different to above)

ABN *

Do you have a Builders Licence (Individual or Business)? *YesNoIf you are applying for a Residential Builder Membership or a Commercial Builder Membership, you must provide a licence.

Licence Number

Class

State

Licence Number

Class

State

Business Email Address *

Office Number

Postal Address *

Suburb *

State *

Postcode *

Is the Physical Address the same as the Postal Address? *YesNo

Physical Address

Suburb

State

Postcode

Primary Contact Name *

Role/Position *

Primary Contact Email Address *

Primary Contact Phone *

Directors/Partners

Director/PartnerDirector(s)Partner(s)

Name

Email Address

Phone

Name

Email Address

Phone

Name

Email Address

Phone

If there are more than 3 directors/partners, please add their details in under the Additional Contacts section below

Additional Contacts

MBA sends out regular member alerts via email. If you have any additional contacts you would like added to the mailing list, please select Yes below.

Do you have any additional contacts you would like to add to the mailing list? *YesNo

How many contacts would you like to add?If more than 5 - please email through details to canberra@mba.org.au

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Name

Email Address

Position

Type of Membership

Select

Estimated Projects(for the next 12 months)

Gross Annual Turnover(last financial year)

What does your business specialise in? *

Reference Check

To become a member, you need to provide us with 100 points of reference

Mandatory
Points	Information
50 points	Nominee by a person (entity) who is: Current MBA ACT financial member; Owner & Director of the member, OR a designated Nominee & Voting Person Has worked with the applicant and can verify their workmanship and/or professionalism.
The remaining 50 points can be made by selecting Option A or Option B Option A: Select TWO of the following options:
Points	Information
25 points	ASIC Search & Credit Report showing neutral or above rating (can be obtained by MBA) – MUST BE A COMPANY
25 Points	Trade Credit Reference from an ACT or Canberra Region based supplier
25 points	Member of another professional organisation. For example, Master Builders NSW, ACT Law Society
25 points	Details of ACT Government Pre-Qualification, OR Confirmation of a Secure Local Jobs Code Certificate (from ACT Government).

Option B: Providing a seconder

Points

Information

50 points

Nominated by a person (entity) who is:

Current MBA ACT financial member;
Owner & Director of the member, OR a designated Nominee & Voting Person
Has worked with the applicant and can verify their workmanship and/or professionalism.

Nominator

To assist with identifying a nominator (current MBA Member) you can find a number of our members via our Find a Member page on our website.

Name *

Business Name *

Email Address *

Phone *

How would you like to make up the remaining 50 points? *Option AOption B

Option A: Please select TWO from the following options

ASIC Search/Credit ReportTrade Credit ReferenceProof of membership from another professional organisationDetails of ACT Government Pre-Qualification OR SLJC Certificate

Contact Name

Business Name

Email Address

Phone

Proof of membership with another professional organisation

No file chosen

Please provide evidence of membership in the form of a membership certificate or letter confirming membership. These documents should show you are a current financial member.

Pre-Qualification or SLJC Certificate

No file chosen

Please upload either details of ACT Government pre-qualification OR confirmation of a Secure Local Jobs Code Certificate (from ACT Government)

Option B: Seconder

Contact Name

Business Name

Email Address

Mobile

Applicant History

Has any principal, partner and/or director of this business:

Had a penalty imposed on them or it by a Building Tribunal or Registrar, in any Australian Jurisdiction? *YesNo

Had a Builder/Trade Licence cancelled, suspended or been issued with a rectification order? *YesNo

Please provide details

Had any special conditions issued on their licence? *YesNo

Been the director of a company that has been placed into external administration or liquidation? *YesNo

Please provide details

Been declared Bankrupt? *YesNo

Been convicted of a criminal offence? *YesNoPlease note: Spent Convictions as defined in the Spent Convictions Act 2000 (ACT) do not need to be declared.

Please provide details

Find a Member

Would you like to included in the Find a Member referral program on our website? *YesNoIf you answer YES you will be sent an additional form to complete once your membership application has been processed

Payment Details

Payment Options *InvoiceCredit Card

Card Number

Expiry

Name on Card

Card Holder's Signature

No file chosen

Please upload image of signature

CVC *

Accounts Email Address

Declaration

Name *

Position *

Date *

Signature *

No file chosen

Please upload image of signature

Next Steps

Please note, the completion of this form does not equate to membership. Once the form has been submitted, a member of our Membership Team will be in contact to discuss pricing with you.

Our team will process your application and perform the required reference checks and then issue you with an interim membership number. Your membership application with then go to our Executive Committee when they meet for formal approval.

What MBA ACT Services are you interested in?

MBA LegalIR/Legal/WHS AdviceDiscounted Short Course TrainingReceiving Member AlertsEvents/MeetingsNetworking OpportunitiesDiscounts (Telstra/Toyota/Ampol/Dell)Insurance (Fidelity Fund/MBIB)OtherA team member will reach out once the membership application has been processed to put you in touch with the relevant service

Other

Save as Draft

Enquiries

General Information

Short Course Training

Apprenticeships

Membership

Events

Become a Member

MBA ACT Membership Application Form

Applicant Details

Directors/Partners

Additional Contacts

Type of Membership

Reference Check

Option A: Please select TWO from the following options

Applicant History

Find a Member

Payment Details

Declaration

What MBA ACT Services are you interested in?

MBA ACT Membership Application
Form