This form can be used by employers in the contract cleaning industry to apply for an exemption from completing a return for a worker who is currently, or was previously, engaged by the employer. We assess each of these applications individually to determine whether the exemption is granted.

Form CCI 9 v1

This form is issued in accordance with Section 64 of the Contract Cleaning Industry (Portable Long Service Leave) Act 2005.

Required fields are marked with an asterisk (*).

Employer details
Worker details
How many workers are you requesting an exemption from lodging a return for? *
File must include worker's name, QLeave number (if known), date of birth, email and phone number
OR manually enter the details of your workers in the fields below Please contact us if you need to add more workers
Reason for exemption
Why are you requesting an exemption from lodging a return for the above worker/s? *
I certify that the information provided is true and correct, and that I am authorised to make this declaration for and on behalf of the employer. *