Declaration by a proposed protected action ballot agent who is not an eligible protected action ballot agent (Form F34D)

Use this form if you are:

• proposing to conduct a protected action ballot, and 
• not an approved eligible protected action ballot agent.

You will need to tell us: 

•  the details of the proposed protected action ballot agent (an individual or a company/industrial association)
•  the details of proposed agent’s representative (if there is one).

You will also need to declare if the proposed protected action ballot agent:

• has agreed to conduct the protected action ballot
• is bound to comply with the Privacy Act 1988 in respect to the handling of information relating to the protected action ballot
• can ensure the secrecy and security of votes cast
• can ensure that the protected action ballot will be fair and democratic, and
• can conduct the protected action ballot expeditiously.

If the proposed agent is an individual, you will also need to declare that you are a fit and proper person to conduct the protected action ballot.

If the proposed agent is a corporation or an industrial association, you will also need to declare:

• who will carry out the functions of the proposed protected action ballot
• if they are a fit and proper person to conduct a protected action ballot 
• the steps the proposed protected action ballot agent will take to ensure that only fit and proper persons will be involved in conducting the protected action ballot.

We store your information in line with the Form F34D privacy notice (pdf).

We will contact you if we need any more information, or to let you know what we decide.

Fair Work Act 2009: Section 444

Fair Work Regulations 2009:  Regulation 3.11