Prospecting Licence Application Form
Mineral Resources (Sustainable Development) Act 1990 (MRSDA)
ALL information required by Schedule 3A of the Mineral Resources Development Regulations 2002 must be provided or the application is invalid. Section 15 of the MRSDA also sets out additional requirements for Prospecting Licences.
Question 11: Expertise of person(s), including the applicant, undertaking the exploration and/or mining program
|Name||Qualifications||Employee of applicant?|
Note: If the person is not an employee of the applicant you must attach evidence that he/she has agreed to assist in the proposed work program.
Question 12: Indicate your experience in mining and exploration activities
I/We currently or have previously held a minerals tenement in Victoria (within last 5 years) under the name given in Question 1 (No further details are required).
I/We have previously held a minerals tenement in Victoria (within last 5 years), under another name (Attach details).
I/We have previously held a minerals tenement outside Victoria (within last 5 years) (Attach details of location and type of most recently held tenements and describe operation).
I/We have not previously held a minerals tenement within last 5 years (Attach details of your knowledge and relevant mining/exploration experience).
Question 13: Indicate with a tick whether any of the following apply to the applicant or associate
Has failed to undertake rehabilitation required under the MRSDA and the Minister has taken action to rehabilitate the land under section 83 of the MRSDA;
Has had a licence cancelled under the MRSDA;
Has been convicted of an offence against the MRSDA;
Has been convicted of an offence involving fraud or dishonesty;
Is insolvent under administration;
If one or more of the above are applicable to either the applicant or an associate of the applicant attach details outlining:
- the name of the party and their relationship to the applicant;
- the nature of the offence;
- when the offence was committed; and
- the penalty imposed (if applicable).
Note - an Associate is defined as a director, partner, trustee, executive officer, secretary or any other officer or person associated or connected with the ownership, administration or management of the applicant's (or licensee's) business.
Question 14: Work program details
The program of work should include:
|A sketch map of the location of the proposed works in relation to the boundaries of the land included in the application; and|
A brief description of the proposed type of works including, if required, the type of ore treatment.
Proposed Type of Operation:
Hard Rock Open Cut
Doze and Detect
Bulk sampling/surface/ trenching/exploration
Hard Rock Underground
Shallow excavation (gypsum, kaolin)
Type of Treatment:
Refer to Prospecting Licence Application Kit for specific details of the program of work requirements.
Question 15: Application Fee
Application for Prospecting Licence $
|Note: The application must be accompanied by the prescribed fee. Refer http://www.dpi.vic.gov.au/about-us/legislation/fees/earth-resources|
I/We declare that to the best of my/our knowledge, all the information I/we have given is true and correct.
Indicate with a tick, the attachments you are submitting with the application:
Map according to the Geocentric Datum of Australia 1994 (GDA94) labelled with MGA (Map Grid of Australia) coordinates showing area covered by application
List of Directors and their Date of Birth details, of the applicant Company (if applicable)
Copy of Certificate of Registration of applicant Company (if applicable)
Evidence of authorisation from applicant for agent to act on their behalf (if applicable)
Work program details
Evidence of financial capability
Statement by non-employee advisors of agreement to act as advisors for this application (if applicable)
Written consent from EL/RL holder/applicant over application area (if applicable).
Application for Section 25A EL holder consent waiver (if applicable)
Other attachments (give details below):
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 Investment 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
Prospecting Licence no:
YOU MUST SUBMIT THIS
| APPLICATION FOR SECTION 25A EXPLORATION LICENCE HOLDER CONSENT WAIVER |
Note: ONLY APPLICABLE IF APPLICATION IS WITHIN AN EXPLORATION LICENCE THAT HAS BEEN REGISTERED FOR MORE THAN 2 YEARS (SEE QUESTION 6).
Manager, Earth Resources Tenements
Department of Primary Industries
Earth Resources Regulation
Level 16, 1 Spring Street
MELBOURNE VIC 3000
ATTENTION: EARTH RESOURCES BUSINESS CENTRE
I/We have applied for a prospecting licence for hectares
The land is covered by Exploration Licence Number
Exploration Licence was first registered on
I/We are unable to obtain the written consent of the holder of the Exploration Licence (evidence attached).
For office use only
Signed: ......................................................., GIS Officer
To the Mining Warden
The Prospecting Licence Application and Exploration Licence Tenement Reports are attached.
Manager Earth Resources Tenements