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Application for Work Authority & Notice of Intention to Commence Work on a Mining Licence or a Prospecting Licence

Tenements Officer
Earth Resources Division
Department of Primary Industries
GPO BOX 4440
MELBOURNE VIC 3001

To the Chief Inspector

APPLICATION FOR WORK AUTHORITY & NOTICE OF INTENTION TO COMMENCE WORK ON A MINING LICENCE OR A PROSPECTING LICENCE number

I/we apply for a work authority to undertake work in accordance with the approved Work Plan.

I/we have complied with the following requirements to enable grant of the authority:
(Tick the boxes below and complete as appropriate)

I/we have an approved Work Plan registered on .

I/we have lodged the rehabilitation bond of $ OR

The rehabilitation bond of $ is enclosed

I/we have a Public Liability Insurance policy in respect of all work authorised by the Work Authority for at least $10 million.

The Work Plan includes private land (See next page for Crown land)

Tick the boxes below as appropriate and attach information if required

The owners and occupiers have given written consent
Attach a copy of that consent

Compensation agreements with the owners and occupiers have been registered in the Mining Register

Compensation was determined by the Tribunal or Court under the Land Acquisition and Compensation Act 1986 and the determination registered in the Mining Register

I/we have purchased the land affected
Attach evidence of the purchase

I/we have been unable to determine the name and address of the owners and occupiers of the land affected.
Attach a supporting statement. You may be required to advertise your intention to start work.

The work plan includes Crown land

Tick the boxes below as appropriate and attach information if required

The land affected is unrestricted Crown land

Consent of the Crown land Minister for work on Restricted Crown land. Attach evidence

I/we notified the owners and occupiers of the affected land (including the Regional Crown land manager in the case of Crown land), of our intention to commence work on (date):

I/we the holder/s of the above mining licence or prospecting licence hereby give notice to the Chief Inspector that I/we intend to commence work in accordance with the approved Work Plan, on grant of the Work Authority.

The contact person for work on this licence is: