Application for Mining Lease · 2020. 9. 2. · Conditional surrender . Attachments required: If...

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September 2020 Page | 1 Application for mining lease Mineral Resources Act 1989 (s245) Form MMOL-14 Version 4 You may make an application for a mining lease electronically using the MyMinesOnline system. A tender application is to be lodged in accordance with the instructions contained in the relevant tender document. Note: A document containing information that is false or misleading may attract a maximum penalty of 200 penalty units. Please read the Mining lease guide (‘the guide’) and other relevant guides before completing this application. Cross where applicable Question 1 – Permit details 1.1 Mining lease type: Non-tender application Mineral Infrastructure (mineral) Transport (s316) (mineral) Corundum, gemstones and other precious stones Infrastructure (corundum, gemstones and other precious stones) Transport (s316) (corundum, gemstones and other precious stones) Elluvial, colluvial and alluvial gold and tin Infrastructure (elluvial, colluvial and alluvial gold and tin) Transport (s316) (elluvial, colluvial and alluvial gold and tin) Coal or oil shale Infrastructure (coal or oil shale) Transport (s316) (coal or oil shale) Prescribed Minerals 1.1a Tender application: Coal Land release number CLR: Mineral Land release number MLR: 1.2 Specify existing permits located over the application area (this may include your pre-requisite permit): For a coal mining lease this can be a prospecting permit, an EPC or a MDL. For an application made under section 271AB this can be an existing exploration permit, MDL or ML. Permit type Permit number Authorised holder Expiry date OFFICE USE ONLY Fees paid: Payment Method: Receipt Number: ________________ Received at: ________________ Total $ _______ Cash Receiving officer I confirm that: the details on application form have been checked; all attachments have been submitted; correct application fees have been submitted for the relevant application type (i.e. an application in a Restricted Area) Name: ___________________________ Signed:___________________________ Date: / / Received by: DNRM Credit Card Date: / / NT AD EFTPOS Time: AM/PM Cheque Name: Date: / / MINES ABN 59 020 847 551

Transcript of Application for Mining Lease · 2020. 9. 2. · Conditional surrender . Attachments required: If...

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    Application for mining lease Mineral Resources Act 1989 (s245)

    Form MMOL-14 Version 4

    You may make an application for a mining lease electronically using the MyMinesOnline system.

    A tender application is to be lodged in accordance with the instructions contained in the relevant tender document.

    Note: A document containing information that is false or misleading may attract a maximum penalty of 200 penalty units.

    Please read the Mining lease guide (‘the guide’) and other relevant guides before completing this application. Cross where applicable

    Question 1 – Permit details

    1.1 Mining lease type: Non-tender application

    Mineral Infrastructure (mineral) Transport (s316) (mineral)

    Corundum, gemstones and other precious stones

    Infrastructure (corundum, gemstones and other precious stones)

    Transport (s316) (corundum, gemstones and other precious stones)

    Elluvial, colluvial and alluvial gold and tin

    Infrastructure (elluvial, colluvial and alluvial gold and tin)

    Transport (s316) (elluvial, colluvial and alluvial gold and tin)

    Coal or oil shale Infrastructure (coal or oil shale) Transport (s316) (coal or oil shale)

    Prescribed Minerals

    1.1a Tender application: Coal Land release number CLR: Mineral Land release number MLR:

    1.2 Specify existing permits located over the application area (this may include your pre-requisite permit): For a coal mining lease this can be a prospecting permit, an EPC or a MDL. For an application made under section 271AB this can be an existing exploration permit, MDL or ML.

    Permit type Permit number Authorised holder Expiry date

    OFFICE USE ONLY Fees paid: Payment Method: Receipt Number: ________________ Received at: ________________ Total $ _______ Cash Receiving officer I confirm that:

    • the details on application form have been checked;• all attachments have been submitted;• correct application fees have been submitted for the

    relevant application type (i.e. an application in aRestricted Area)

    Name: ___________________________

    Signed:___________________________ Date: / /

    Received by: DNRM Credit Card

    Date: / / NT AD EFTPOS

    Time: AM/PM Cheque

    Name: Date: / /

    MINES ABN 59 020 847 551

    https://www.business.qld.gov.au/industries/mining-energy-water/resources/minerals-coal/online-services/myminesonline

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    1.3 General locality of the

    application:

    1.4 Is the lease for a prescribed mineral? Yes No 1.5 Will the lease meet the threshold within the first 5 years? Yes No

    1.10 Amount of mineral proposed to be mined:

    1.11 Is the lease part of an existing project? Yes No

    1.6 Permit application name (your reference only): 1.7 Term of permit: years

    1.8 Mineral/s sought:

    1.9 Additional purposes the mining lease is sought for, e.g. infrastructure, other

    Rehabilitation / remediation

    purposes associated with mining:

    Attachments required: • Statement justifying the term you are applying for

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    Question 2 – Permit holder details (if more than two holders provide a separate attachment) 2.1 Authorised holder (Principal holder) Company name / surname:

    Given name (if individual): ACN/ARBN:

    Address:

    Town/City: State: Postcode:

    Country: Phone no.:

    Date of birth: (if individual):

    Email:

    Sole tenant Percentage holding: %

    2.2 Other holders (if applicable)

    Company name / surname:

    Given name (if individual): ACN/ARBN:

    Address:

    Town/City: State: Postcode:

    Country: Phone no.:

    Date of birth: (if individual):

    Email:

    Tenants in common Joint tenants Percentage holding: %

    2.3 Authorised holder representative (authorised person to act as contact for this permit)

    Name:

    Contact:

    Address:

    Town/City: State: Postcode:

    Country: Phone no.:

    Email:

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    Question 3 – Details of permit area

    3.1 Size of area : hectares

    3.2 Has a datum post been inserted? Yes No 3.3 Provide coordinates for datum post/ reference point:

    *coordinates must be in latitude and longitude on GDA 2020 datum. Datum post/reference point may include another physical monument Note: refer to section 245 of the Mineral Resources Act 1989 and Practice Direction 1/2016: Boundary identification for resource authorities for information on marking out boundary and description of application area

    3.4 Has the land been marked out, if so, provide date of marking out?

    3.5 Local authority:

    Internal/external boundary: 3.6 Is there an existing mining permit (or existing application for a mining permit) wholly within this new permit application? Yes No

    If yes, specify the permit details:

    Permit type Permit number Authorised holder Expiry date

    3.7 Area description (include external and internal boundary description) by providing details below or provide an electronic shape file using the Shape file templates available on our website with the application form. Refer to Shape file guide for more information. Permit location, list coordinates of all corners as accurately as possible Post/Physical Monument Latitude Longitude

    Attachments required: • Proof of identity for each applicant (this includes individual and company certificate of registration)

    • Letter of authority from all applicants for authorised holder representative to act on behalf of holders for this permit (not required if holder is an individual (not company) and representing themselves)

    • If the applicant is a company, attach a document providing a list of directors and company secretary of the company (including dates of birth)

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    Coordinates capture method GPS device

    Model/type of GPS unit

    Accuracy of GPS +/- metres Other

    eg. Derived from GeoResGlobe using a screen hit

    Surface area: 3.8 What surface area is required? Whole Part Nil

    3.9 Part surface - What area is required? hectares

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    3.10 Surface area description - by providing details below or provide an electronic shape file using the Shape file templates available on our website with the application form. Refer to Shape file guide for more information. Latitude Longitude

    *Attach as a separate list if insufficient space 3.11 Nil surface - Specify the permit with surface area that adjoins the application area:

    Permit type Permit number Authorised holder Expiry date

    Access: 3.12 Is access to the permit application by a dedicated road that is within or is abutting the permit area? Yes No

    3.13 If yes - Provide the name of the dedicated road: Go to question 4

    3.14 If no - What is the width of access: Metres (two decimals)

    3.15 Provide any relevant information about the access including start and end points:

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    3.16 - Access description - by providing details below or provide an electronic shape file using the Shape file templates available on our website with the application form. Refer to Shape file guide for more information. Latitude Longitude

    *Attach as a separate list if insufficient space

    Attachments required: • Map of proposed permit area including external, internal boundary, access and surface area (if part)

    • Provide any other supporting documents or graphic representation of the area e.g. photos

    • Whole or part surface area: provide a statement justifying why surface area is required

    • Provide information about any resource authorities and land parcel details that abut the boundary, for example NE corner abuts NW corner of MC5646, western boundary abuts the eastern boundary of Lot 25 on RP143567

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    Question 4 – Land information

    Land parcel details

    4.1 Provide property details for all land parcels covered by the permit (including access) (add a separate page if insufficient space or use Land information template available on our website and attach to form).

    Lot Plan Tenure Land Parcel name Current usage Proposed usage Landowner name Landowner address Is

    compensation required?

    Erosion control works

    on land

    Eg. 1 RP123123 FH Smith road Grazing Mining or Access J Smith 123 Brisbane Rd, Brisbane Yes or No Yes or No

    Note: Q4 is not required for tender applications. Refer to the relevant tender document

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    Adjoining land

    4.2 Provide property details for all land parcels adjoining the permit (add a separate page if insufficient space or use Adjoining land information template available on our website and attach to form)

    Lot Plan Tenure Land Parcel name Landowner name Landowner address Eg. 1 RP123123 FH Smith road J Smith 123 Brisbane Rd, Brisbane

    Restricted land

    4.3 Are there any permanent buildings/relevant features within the application area or within the prescribed distances laterally of the boundary? Yes No

    4.4 If yes - Describe the permanent building or relevant structures or provide an electronic shape file of the restricted land using the Shape file templates available on our website with the application form. Refer to Shape file guide for more information.

    4.5 Do you have written consent from the owner/occupier of the land with permanent buildings or relevant structures? Yes No

    Attachments required:

    If yes to 4.5 - Consent from the owner of land

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    Reserve land

    4.6 Is the application area within the surface of reserve land? Yes No

    4.7 Do you have written consent from the owner of the reserve? Yes No

    Overlapping permits 4.8 Specify any production or exploration permits overlapping with the application area

    Permit type Permit number Authorised holder Expiry date

    *This applies to: exploration permit, mineral development licence, mining claim, mining lease, authority to prospect, petroleum lease, geothermal exploration permit, geothermal lease.

    Note: Chapter 4 of the Mineral and Energy Resources (Common Provisions) Act 2014 outlines the overlapping requirements that may apply to your application if it is overlapping with a petroleum authority for coal seam gas under the Petroleum and Gas (Production and Safety) Act 2004. Greenhouse Gas tenure overlap

    4.9 Is the application area situated within an area of a greenhouse gas (GHG) tenure? Yes No 4.10 If yes - Specify the GHG tenure details:

    Permit type Permit number Authorised holder Expiry date

    Conditional surrender

    Attachments required:

    If yes to 4.7 - Consent from the owner of the reserve Consent is required before the application can be decided

    Attachments required:

    Provide a GHG statement and any other information that addresses the GHG assessment criteria If overlapping with a petroleum lease granted before commencement of Chapter 4 of the Mineral and Energy Resources (Common Provisions) Act 2014 - provide a CSG statement

    4.11 Are you seeking to surrender a granted mining lease in favour of whole or part of this application? Yes No

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    4.12 If yes - Specify the mining lease details:

    Permit type Permit number Authorised holder Expiry date

    Question 5 – Environmental authority

    Note: Q5 is not required for tender applications. Refer to the relevant tender document

    Please submit the relevant Environmental Authority (EA) application with the Department of Environment and Science (DES) via Online Services. For more information on DES’ online system or if you have not registered please visit the DES website https://www.business.qld.gov.au/running-business/environment/online-services. Alternatively you can access environmental forms online from https://www.business.qld.gov.au/running-business/environment/licences-permits/forms-fees and lodge at a DES office. The resource authority may not be decided until the EA has been issued. You will also need to ensure you are a Registered Suitable Operator under the Environmental Protection Act 1994. More information available from https://environment.des.qld.gov.au/licences-permits/suitable-operators/

    Question 6 – Native title

    Note: Q6 is not required for tender applications. Refer to the relevant tender document Please ensure that you have read and understood the Guide to the native title process and supporting policies

    6.1 Please elect which native title process you wish to undertake.

    Option 1 Excluded No native title process is required as I have determined that 100% of the permits area is exclusive of native title.

    (Go to Q7)

    Option 2 Right to negotiate Advertising cost required and Right to negotiate submission (Q6.2

    must be completed)

    Option 3 Right to negotiate and ILUA (existing, private or state ILUA)

    Advertising cost required Requires monthly updates be submitted to the department (for new private ILUA) and Right to negotiate submission

    (Q6.2 must be completed)

    Option 4 New Private ILUA Requires monthly updates be submitted to the department (Go to Q7)

    Option 5 Opt into existing private ILUA Name: or Number:

    (Go to Q7)

    Option 6 State ILUA Name:

    (Go to Q7) Attachments required: Private ILUA or extract of private ILUA (Option 3,5)

    Opt in deed for ILUA (Option 3,5,6)

    Right to negotiate submission (template available on Departments website)

    Attachments required: Rationale for conditional surrender

    https://www.business.qld.gov.au/running-business/environment/online-serviceshttps://www.business.qld.gov.au/running-business/environment/online-serviceshttps://www.business.qld.gov.au/running-business/environment/licences-permits/forms-feeshttps://www.business.qld.gov.au/running-business/environment/licences-permits/forms-feeshttps://environment.des.qld.gov.au/licences-permits/suitable-operators/

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    6.2 If you have elected to undertake a native title option that requires advertising, please select which advertising method you wish to undertake from one of the options below:

    * The advertising fee should be attached to this application. The department will provide you a copy of the advertisement prior to publication. Any overpayment will be refunded by the Department.

    Question 7 – Mining program/Initial development plan For coal mining lease – provide an initial development plan that complies with the legislation. Refer to development plan guide for more information.

    For a Prescribed mineral mining lease – Where a mining lease for a prescribed mineral reaches the threshold, an initial development plan that complies with the legislation must be lodged. Refer to development plan guide for more information.

    For mineral mining lease (other than coal) - complete the mining program template with details of activities to be undertaken. A template is available online which you can complete and attach to this application, or complete all sections below.

    7.1 When are operations expected to commence on this mining lease?

    7.2 Is this mining lease being or to be operated in conjunction with other mining permits as part of a project? Yes No

    If yes, provide details of the project including a description of the relationship of this lease to the project and why this lease is required for the project or operation of other permits.

    Multiple advertisement (batched advertising) $1000.00 Single advertisement $3000.00

    I agree to my application being advertised with the right to negotiate native title process *

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    7.3 Describe the method of operations to be undertaken? This statement must: • Cover every mineral that the lease holder or applicant has (or will have) the right to mine. • If the lease was granted for a purpose other than mining, cover the use of the mining lease for the purpose it was

    granted for. • Describe the method in enough detail to support the size, shape eg overburden dumps, pits, stockpiles, processing

    etc. • Provide adequate graphic representations (i.e. maps, photos, diagrams) of the resource and mining information to

    support the proposed use. • Include a description of infrastructure to be constructed /maintained on the lease or necessary to enable the mining

    program to proceed, or additional activities to be carried out to work out the infrastructure requirements. • Describe the methods proposed for rehabilitation works. • Include a description of the workforce to establish/maintain this operation.

    *If insufficient space, please use the mining program template available on the Departments website.

    Attachments required:

    Completed mining program template (if section above is not completed) Map of permits within project

    Coal mining lease/prescribed mineral mining lease - Initial development plan

    For a later specific purpose mining lease or a later transportation lease: Provide a statement about how the authorised activities for the lease can be carried out in a way that is compatible with the authorised activities for the existing authority; and

    Provide a statement about how the co-existence of the later lease and the existing authority would optimise the development and use of the State’s resources

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    Question 8 – Financial and technical capability Please tick one of the below statements and attach the required financial and technical documents and statements according to your exploration and mining history.

    I/we have more than five (5) years history in Queensland with a good compliance record.

    I/we have less than five (5) years compliance and history in Queensland or do not wish to rely on my/our history.

    Financial information: Financial capability statement

    Details of other financial commitments in relation to activity in Queensland

    Financial information:

    Financial capability statement Supporting evidence

    Details of other financial commitments in relation to activity in Queensland

    Technical information:

    Technical capability statement

    Details of other human / technical resource commitments in relation to activity in Queensland

    Third party declaration (if a third party is providing resources for your program)

    Technical information:

    Technical capability statement

    Details of other human / technical resource commitments in relation to activity in Queensland

    Third party declaration (if a third party is providing resources for your program)

    Supporting evidence

    Question 9 – Obligations and declaration WARNING: Giving false or misleading information is a serious offence.

    • I have read and understood the Mining lease and other relevant guides. • I understand my obligations as an applicant/holder for a mining lease. • I have truthfully declared all relevant details requested of me in this application. • If any part of this form has been completed with the assistance of another person, I declare that the information as set

    down is true and correct and has been included with my full knowledge, consent and understanding.

    Print name: Signature:

    Position: Date:

    Company:

    Print name: Signature:

    Position: Date:

    Company:

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    Print name: Signature:

    Position: Date:

    Company:

    Print name: Signature:

    Position: Date:

    Company:

    Question 10 – Payment

    Note: Q10 refer to the relevant tender document for more information about payment

    Permit application Application fee Coal

    Native title Multiple advertisement (batched advertising) Single advertisement

    Tenders are to be lodged in accordance with the instructions contained in the relevant tender

    document Disclaimer The Queensland Government is collecting information provided on and with this form to assess the suitability of the application for mining lease under the Mineral Resources Act 1989 (the MRA). This information is authorised by sections 245 of the MRA and section 197 of the Mineral and Energy Resources (Common Provisions) Act 2014 (MERCP). Some or all of this information may be provided to other agencies of the Queensland Government for issuing an environmental authority, to make register searches, extracts or copies or to make other approvals as required under the relevant Act. Any information provided as part of the application process may be provided to the Land Court as part of the Land Court recommendation process under the MRA. Some of this information may be provided to Queensland Treasury, the Scheme Manager under the Mineral and Energy Resources (Financial Provisioning) Act 2018 (MERFP Act), or any advisors to the Scheme Manager to enable the Scheme Manager to carry out the Scheme Manager’s functions under the MERFP Act. Your personal information will not otherwise be disclosed to any other third party without your consent, unless authorised or required by law.

    undefined_19: OffLand release number CLR: undefined_20: OffLand release number MLR: Permit typeRow1: Permit numberRow1: Authorised holderRow1: Expiry dateRow1: Permit typeRow2: Permit numberRow2: Authorised holderRow2: Expiry dateRow2: Permit typeRow3: Permit numberRow3: Authorised holderRow3: Expiry dateRow3: Permit typeRow4: Permit numberRow4: Authorised holderRow4: Expiry dateRow4: Permit typeRow5: Permit numberRow5: Authorised holderRow5: Expiry dateRow5: Permit typeRow6: Permit numberRow6: Authorised holderRow6: Expiry dateRow6: undefined_21: Offundefined_22: Offundefined_23: Offundefined_24: Off17 Term of permit: 110 Amount of mineral proposed to be mined: undefined_25: Offundefined_26: OffCompany name: Given name: ACNARBN: undefined_28: TownCity: State: Postcode: undefined_29: Phone no: Date of birth: undefined_30: Sole tenant: OffPercentage holding: Company name_2: Given name_2: ACNARBN_2: undefined_31: TownCity_2: State_2: Postcode_2: undefined_32: Phone no_2: Date of birth_2: Tenants in common: OffJoint tenants: Offundefined_33: Percentage holding_2: 23 Authorised holder representative authorised person to act as contact for this permit: undefined_34: undefined_35: TownCity_3: State_3: Postcode_3: undefined_36: Phone no_3: undefined_37: 31 Size of area: Yes_4: OffNo_4: Offcoordinates must be in latitude and longitude on GDA 2020 datum Datum postreference point may include another physical monument: 34 Has the land been marked out if so provide date of marking out: undefined_38: OffPermit typeRow1_2: Permit numberRow1_2: Authorised holderRow1_2: Expiry dateRow1_2: Permit typeRow2_2: Permit numberRow2_2: Authorised holderRow2_2: Expiry dateRow2_2: PostPhysical MonumentRow1: LatitudeRow1: LongitudeRow1: PostPhysical MonumentRow2: LatitudeRow2: LongitudeRow2: Modeltype of GPS unit: metres: eg Derived from GeoResGlobe using a screen hitRow1: eg Derived from GeoResGlobe using a screen hitRow2: eg Derived from GeoResGlobe using a screen hitRow3: Whole: OffPart: OffNil: Off39 Part surface What area is required: LatitudeRow1_2: LongitudeRow1_2: LatitudeRow2_2: LongitudeRow2_2: LatitudeRow3_2: LongitudeRow3_2: LatitudeRow4: LongitudeRow4: LatitudeRow5: LongitudeRow5: LatitudeRow6: LongitudeRow6: LatitudeRow7: LongitudeRow7: LatitudeRow8: LongitudeRow8: LatitudeRow9: LongitudeRow9: LatitudeRow10: LongitudeRow10: LatitudeRow11: LongitudeRow11: LatitudeRow12: LongitudeRow12: Permit typeRow1_3: Permit numberRow1_3: Authorised holderRow1_3: Expiry dateRow1_3: Permit typeRow2_3: Permit numberRow2_3: Authorised holderRow2_3: Expiry dateRow2_3: Yes_6: OffNo_6: Off313 If yes Provide the name of the dedicated road: 314 If no What is the width of access: 315 Provide any relevant information about the access including start and end points: LatitudeRow1_3: LongitudeRow1_3: LatitudeRow2_3: LongitudeRow2_3: LatitudeRow3_3: LongitudeRow3_3: LatitudeRow4_2: LongitudeRow4_2: LatitudeRow5_2: LongitudeRow5_2: LatitudeRow6_2: LongitudeRow6_2: LatitudeRow7_2: LongitudeRow7_2: LatitudeRow8_2: LongitudeRow8_2: LatitudeRow9_2: LongitudeRow9_2: LatitudeRow10_2: LongitudeRow10_2: LatitudeRow11_2: LongitudeRow11_2: LatitudeRow12_2: LongitudeRow12_2: LatitudeRow13: LongitudeRow13: Eg 1Row1: RP123123Row1: FHRow1: Smith roadRow1: GrazingRow1: Mining or AccessRow1: J SmithRow1: 123 Brisbane Rd BrisbaneRow1: Eg 1Row2: RP123123Row2: FHRow2: Smith roadRow2: GrazingRow2: Mining or AccessRow2: J SmithRow2: 123 Brisbane Rd BrisbaneRow2: Eg 1Row3: RP123123Row3: FHRow3: Smith roadRow3: GrazingRow3: Mining or AccessRow3: J SmithRow3: 123 Brisbane Rd BrisbaneRow3: Eg 1Row4: RP123123Row4: FHRow4: Smith roadRow4: GrazingRow4: Mining or AccessRow4: J SmithRow4: 123 Brisbane Rd BrisbaneRow4: Eg 1Row5: RP123123Row5: FHRow5: Smith roadRow5: GrazingRow5: Mining or AccessRow5: J SmithRow5: 123 Brisbane Rd BrisbaneRow5: Eg 1Row6: RP123123Row6: FHRow6: Smith roadRow6: GrazingRow6: Mining or AccessRow6: J SmithRow6: 123 Brisbane Rd BrisbaneRow6: Eg 1Row7: RP123123Row7: FHRow7: Smith roadRow7: GrazingRow7: Mining or AccessRow7: J SmithRow7: 123 Brisbane Rd BrisbaneRow7: Eg 1Row8: RP123123Row8: FHRow8: Smith roadRow8: GrazingRow8: Mining or AccessRow8: J SmithRow8: 123 Brisbane Rd BrisbaneRow8: Eg 1Row9: RP123123Row9: FHRow9: Smith roadRow9: GrazingRow9: Mining or AccessRow9: J SmithRow9: 123 Brisbane Rd BrisbaneRow9: Eg 1Row10: RP123123Row10: FHRow10: Smith roadRow10: GrazingRow10: Mining or AccessRow10: J SmithRow10: 123 Brisbane Rd BrisbaneRow10: Eg 1Row11: RP123123Row11: FHRow11: Smith roadRow11: GrazingRow11: Mining or AccessRow11: J SmithRow11: 123 Brisbane Rd BrisbaneRow11: Eg 1Row12: RP123123Row12: FHRow12: Smith roadRow12: GrazingRow12: Mining or AccessRow12: J SmithRow12: 123 Brisbane Rd BrisbaneRow12: Eg 1Row1_2: RP123123Row1_2: FHRow1_2: Smith roadRow1_2: J SmithRow1_2: 123 Brisbane Rd BrisbaneRow1_2: Eg 1Row2_2: RP123123Row2_2: FHRow2_2: Smith roadRow2_2: J SmithRow2_2: 123 Brisbane Rd BrisbaneRow2_2: Eg 1Row3_2: RP123123Row3_2: FHRow3_2: Smith roadRow3_2: J SmithRow3_2: 123 Brisbane Rd BrisbaneRow3_2: Eg 1Row4_2: RP123123Row4_2: FHRow4_2: Smith roadRow4_2: J SmithRow4_2: 123 Brisbane Rd BrisbaneRow4_2: Eg 1Row5_2: RP123123Row5_2: FHRow5_2: Smith roadRow5_2: J SmithRow5_2: 123 Brisbane Rd BrisbaneRow5_2: Eg 1Row6_2: RP123123Row6_2: FHRow6_2: Smith roadRow6_2: J SmithRow6_2: 123 Brisbane Rd BrisbaneRow6_2: Eg 1Row7_2: RP123123Row7_2: FHRow7_2: Smith roadRow7_2: J SmithRow7_2: 123 Brisbane Rd BrisbaneRow7_2: Eg 1Row8_2: RP123123Row8_2: FHRow8_2: Smith roadRow8_2: J SmithRow8_2: 123 Brisbane Rd BrisbaneRow8_2: Eg 1Row9_2: RP123123Row9_2: FHRow9_2: Smith roadRow9_2: J SmithRow9_2: 123 Brisbane Rd BrisbaneRow9_2: Yes_7: OffNo_7: Offinformation: Yes_8: OffNo_8: OffYes_9: OffNo_9: OffYes_10: OffNo_10: OffPermit typeRow1_4: Permit numberRow1_4: Authorised holderRow1_4: Expiry dateRow1_4: Permit typeRow2_4: Permit numberRow2_4: Authorised holderRow2_4: Expiry dateRow2_4: Permit typeRow3_2: Permit numberRow3_2: Authorised holderRow3_2: Expiry dateRow3_2: Permit typeRow4_2: Permit numberRow4_2: Authorised holderRow4_2: Expiry dateRow4_2: Yes_11: OffNo_11: OffPermit typeRow1_5: Permit numberRow1_5: Authorised holderRow1_5: Expiry dateRow1_5: Permit typeRow2_5: Permit numberRow2_5: Authorised holderRow2_5: Expiry dateRow2_5: Permit typeRow3_3: Permit numberRow3_3: Authorised holderRow3_3: Expiry dateRow3_3: Yes_12: Offundefined_42: OffPermit typeRow1_6: Permit numberRow1_6: Authorised holderRow1_6: Expiry dateRow1_6: Permit typeRow2_6: Permit numberRow2_6: Authorised holderRow2_6: Expiry dateRow2_6: 71 When are operations expected to commence on this mining lease: Yes_13: Offundefined_49: Offis required for the project or operation of other permits: If insufficient space please use the mining program template available on the Departments website: Print name: Position: Company: Print name_2: Position_2: Company_2: undefined_53: undefined_55: Print name_3: Position_3: Company_3: 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    1: 0: 1:

    2: 0: 1:

    Check Box103: OffCheck Box104: OffCheck Box105: OffPostPhysical MonumentRow3: 0: 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12:

    LatitudeRow3: 0: 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12:

    LongitudeRow3: 0: 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12:

    Check Box106: OffCheck Box107: OffCheck Box108: OffCheck Box109: OffCheck Box110: OffCheck Box111: OffDropdown112: 1: [Select]2: [Select]3: [Select]4: [Select]5: [Select]6: [Select]7: [Select]8: [Select]9: [Select]10: [Select]11: [Select]0: 0: [Select]1: 0: [Select]1: [Select]2: [Select]3: [Select]4: [Select]5: [Select]6: [Select]7: [Select]8: [Select]9: [Select]10: [Select]11: [Select]

    Check Box113: OffCheck Box114: OffCheck Box115: OffCheck Box116: OffCheck Box117: OffCheck Box118: 0: Off1: Off2: Off3: Off4: Off5: Off

    Text119: 0: 1: 2:

    Check Box120: OffCheck Box121: OffCheck Box122: OffCheck Box123: OffCheck Box124: OffCheck Box125: OffCheck Box126: OffCheck Box127: OffCheck Box128: OffCheck Box129: OffCheck Box130: OffCheck Box131: OffCheck Box132: OffCheck Box133: OffCheck Box134: Off