Complete all sections of the form and submit it by either:

The form can either be submitted;

By post:

Department of Energy, Mines, Industry Regulation and Safety
Licensing Services
Locked Bag 100
East Perth WA 6892

or in person at: 

Level 1 Mason Bird Building
303 Sevenoaks Street (entrance Grose Avenue)
Cannington WA 6107

Please note: In order to safeguard your credit card information, your completed 'Request for a Duplicate Licence/Certificate' form must not be emailed back to DMIRS.

Please visit the licensing fees page and go to the relevant industry section for the current fee.