Excell Group

Subcontractor Network

Subcontractor Registration

Interior Designer

Please complete all sections in full and return to: info@excellgroup.au

Business Details

Company Name *

Trading Name (if different)

ABN

Business Structure

Legal Entity Name (as registered with ABN)

Primary Contact

Full Name *

Position / Title

Mobile *

Email Address *

Business Address

Street Address

Suburb

State / Postcode

Professional Registration (voluntary)

Design Institute of Australia (DIA) Membership No. (if held)

Interior design is an unlicensed profession in Victoria. Registration with the Design Institute of Australia (DIA) is voluntary.

Insurance

Public Liability ($5m minimum required)

Public Liability Insurer

Policy Number

Coverage Amount

Expiry Date

WorkCover

Employ workers or apprentices?

WorkCover Insurer

Policy Number

Expiry Date

Required if you employ workers or apprentices.

Professional Indemnity (recommended)

PI Insurer

Policy Number

Coverage Amount

Expiry Date

Recommended for this profession.

Banking & Payment

Account Name

BSB

Account Number

Payment Terms

GST Registered?

Safety Tickets

White Card

White Card No.

Please attach a copy in the Documents section below.

Notes

Additional Certificates

Certificate / Qualification

Certificate No.

Issuing Body / RTO

Expiry Date

Site Undertakings

I confirm I will provide a trade specific Safe Work Method Statement (SWMS) prior to commencing any High Risk Construction Work on site *

Documents

Click to choose files, or drag them here

PDF or image · up to 12 files · 10 MB each

White Card (photo or scan)
Public Liability Certificate of Currency
WorkCover Certificate of Currency (if applicable)
Licence / Registration card
Any High Risk Work licences
Professional Indemnity Certificate of Currency (if applicable)

✓

Declaration

I declare that the information provided in this form is true and correct. I understand that providing false or misleading information may result in immediate termination of engagement with Excell Group. I agree to notify Excell Group immediately of any changes to my licence, insurance, or qualification status.

I have read and agree to the declaration above. *

Full Name (as signature) *

Date *

Fields marked * are required.

Excell Group · Melbourne, VIC · info@excellgroup.au · Confidential