(Do not show a Post Box Number. Must be registered office address if a company.)
Note: If more than two applicants please attach details onto a separate page.
Personal information provided by you for the purpose of your application and any related purpose (including the issue of a licence) is collected, used and stored by DPI to assist in the performance of duties under the MRSDA.
You have the right of access to this information by contacting the Earth Resources Business Centre, Department of Primary Industries, 16th Floor, 1 Spring St, Melbourne VIC 3000.
The information may be disclosed to the Victoria Police, the Australian Securities and Investments Commission and other government organisations for the purpose of administering or enforcing the Act or a relevant Act. Limited information may be available to the public for the purpose of land use advice.
Office Use Only
Delivered: In person / By post
Exploration Licence no:District:
|YOU MUST SUBMIT THIS |
THE EARTH RESOURCES
16TH FLOOR, 1 SPRING ST
MELBOURNE VICTORIA 3000
(GPO BOX 4440, MELBOURNE VICTORIA
PRIORITY IS ALLOCATED ACCORDING TO
THE DAY THE APPLICATION IS RECEIVED
THE BUSINESS CENTRE