Key Application Form DIA

E-Key Application

This form is to be used when applying for new or replacement keys for areas operated by Darwin International Airport.Your business must be registered with us before you can apply for a key; if your business is not currently registered, please complete your business registration HERE.

There is a $100.00 deposit payable for all DIA issued keys.

PART 1 - COMPANY DETAILS

Initial ApplicationReplacement

Original Key Serial Number *To obtain Original Key Serial Number, please contact TCC on (08) 8920 1822.

Company Name *

Authorised Signatory *

Preferred Contact Number *

Email *Please note that the email address you provide here will be utilised to send notifications of key expiry dates to remind the holder to update their key/s

A Statutory Declaration detailing a lost, stolen or destroyed key must be provided to TCC prior to new key being issued

PART 2 - ACCESS REQUIREMENTS

Before DIA can issue a key to your company you must provide information regarding where access is required and what the operational requirement is to access those areas.

Areas required to access *

Reason for access *You must be specific in this area; please justify company’s need to access certain secure areas by stating actions and duties carried out in those areas

Number of keys required *

PART 3 - CERTIFICATION

EMPLOYER CERTIFICATION

To be completed by authorised signatory only:

I, *Enter Full Name

hereby:

(i) Certify that the information provided on this form is correct and agree to notify DIA of any changes to the above particulars;

(ii) Confirm that access is required to the areas stated above in order for the company to successfully operate and that the operational requirement stated is true and correct;

(iii) Acknowledge that I have read the attached Conditions of Use, and I understand and agree to comply with the conditions and supply these conditions to all persons who may utilise the DIA issued key;

(iv) Understand that incorrect use of a DIA issued key may result in immediate withdrawal of the key and further action as deemed necessary by DIA

Signed *

Draw signature|Type signatureClear

Date *

KEY CONDITIONS OF ISSUE AND USE

CONDITIONS OF ISSUE AND USE

•Loss or theft of a key that provides access to DIA Secure Areas must be reported immediately to Darwin International Airport Terminal Control Centre – (08) 8920 1822.

•Keys must be returned to DIA if the company no longer has an operational requirement to access areas for where the keys provide access.

•Access provided by DIA issued keys is registered for the use of the company to whom it has been issued only.

•The access provided by a DIA issued key may only be used in the course of company approved duties in the Secure Areas and does not constitute an authority to enter or remain in a restricted area for any other purpose.

•Only persons with a valid DRW or AUS ASIC are permitted to access the Security Restricted Areas of the Airport.

•Only persons with a valid Airside Drivers Licence (ADA) in a vehicle with a valid Authority to use Airside Permit (AUA) are permitted to access through vehicle gates.

•No gates or doors are to be left or propped open under any circumstances.

•Incorrect use of access provisions may result in the immediate withdrawal of access control.

•When not in use, keys are to be kept in a safe place, and the company will do their utmost to ensure their security at all times.

•It is the company’s responsibility to maintain a register detailing the holder of each DIA issued key, DIA may, from time to time, request a copy of these records for the purposes of conducting an audit of key use.

•All DIA keys remain the property of DIA at all times and must be returned at DIA’s request.

•The company and the company’s authorised personnel who utilise DIA issued keys are bound by the conditions of use, and will be held responsible for any breaches.

PAYMENT OPTIONS

There is a $100.00 deposit payable for all DIA issued keys. You must retain your receipt and produce this when returning your key in order to be refunded your deposit, the deposit will only be refunded to the company stated on the receipt. Deposits will be refunded on return of a key less the cost of restoring the key to its original condition, which at a minimum will be a new battery and new tip at approximately $30.00. DIA will determine the final deposit refund applicable.

Total Deposit

Credit Card Processing Fees *

Payment Amount *

Enter email address to receive tax receipt *

*Credit card details will be asked for at the bottom of this form. A credit card processing fee will be added for all credit card transactions.

*Please ensure correct cash is presented to TCC during collection of Key

*If you are unsure if monthly account payments have been set up for your company, please contact TCC office on (08) 8920 1822.

NA Reason *

Receipt Number *

PRIVACY STATEMENT

Collection and disclosure to third parties of the information contained within this application form is required in order to enable theprocessing of Access Control onto your DIA issued Access Card. The collection and handling of information is in compliance with Division9 - Aviation Transport Security Act 2004, Part 6 - Aviation Transport Security Regulations 2005, AusCheck Regulations 2007, DarwinInternational Airport Transport Security Program and The Privacy Act 1988.

In addition, we may use your personal information for the purposes of assisting DIA with the correct operating of the airport under variouslegislation, and in the assessment of any possible security incidents or breaches. Information may also be supplied to third parties inconjunction with any federal investigations.

By submitting this application, you consent to DIA collecting, using and disclosing personal information as set out above.

OFFICE USE ONLY

PROCESSING

Application Received *

Key Coded Date *

Key Collected by Company *

Expiry *

None30 Days

Expiry Date *

DEPOSIT

Payment Method *

Receipt Number *

Payment Method *

CashCredit Card / EFTPOSMonthly AccountNA

Receipt Number *

N/A Reason *

Notes

Processed By *Enter Full Name

CAPTCHA *

Credit Card Payment *

Pay

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