Affected member certificate
Form 4 Affected member certificate
(regulation 3.29)
Fair Work Regulations 2009, regulation 3.29
AFFECTED MEMBER CERTIFICATE
This certificate is issued to [name of organisation].
Section 520 of the Fair Work Act 2009 authorises the Fair Work Commission to issue an affected member certificate if a permit holder seeks to enter premises for the purpose of investigating contraventions, or suspected contraventions, of the Fair Work Act 2009, or a term of a fair work instrument.
For section 520 of the Fair Work Act 2009, the Fair Work Commission is satisfied that:
- a member of the organisation performs work on the premises below; and
- the organisation is entitled to represent the industrial interests of the member; and
- a suspected contravention of the Fair Work Act 2009, or a term of a fair work instrument, relates to, or affects, that member.
For this certificate:
The premises to which it relates are:
[name and address of premises]
The suspected contravention or contraventions to which it relates are:
[particulars of suspected contravention or contraventions]
Dated 20
Delegate of the Fair Work Commission
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