Declaration of criminal history particulars

Complete your Declaration of criminal history particulars (NAT 74815, 284KB) form in Portable Document Format (PDF).

When to use this form



This information may not apply to the current year. Check the content carefully to ensure it is applicable to your circumstances.

End of attention

You should complete this form if you have been asked to do so in a licence, periodic settlement permission or movement permission application.

We use this form to assess an applicant's suitability for a licence or permission. Without it, we may be unable to grant a licence or permission.


Completing your form

Section A: Declaration form details

Provide the name of the applicant (or the licence/permission holder) and the type of licence or permission this form relates to.

Section B: Your details

Provide the personal details requested.

Section C: Disclosure details on criminal history

Ensure you answer all of the questions.

Section D: Declaration

You must declare that all the information you have provided in this form is true and correct.

If we later discover that you provided false or misleading information, we may not grant the licence or permission or we may cancel your licence or permission.


For information about your privacy refer to the full privacy statement at

Last modified: 19 Jan 2016QC 43561