ACN: (if applicable) ABN: (if applicable) Primary Contact Person: Position: Postal Address: State: Postcode: Phone: : Contact Details: Fax: Email: Part C Details of Operator (if different) – Name of the Operator: Primary Contact Person: Operator’s ACN (if a corporation): Operator’s ABN (if a corporation): Business Address of the Operator: Postcode: Postal Address (if different from above): State: Postcode: Phone: : Contact Details: Fax: Email: Part D Details of Fracture Stimulation Contractor – Contractor Name: ACN: (if applicable) ABN: (if applicable) Primary Contact Person: Postal Address: State: Postcode: Phone: : Contact Details: Fax: Part E Well Details – Well Set Name: Well Name: Eastings: Northings:
ACN: (if applicable) ABN: (if applicable) Primary Contact Person: Position: Postal Address: State: Postcode: Contact Details: Phone: : Fax: Email: Part C – Details of Operator (if different) Name of the Operator: Primary Contact Person: Operator’s ACN (if a corporation): Operator’s ABN (if a corporation): Business Address of the Operator: Postcode: Postal Address (if different from above): State: Postcode: Contact Details: Phone: : Fax: Email: Part D – Details of Fracture Stimulation Contractor Contractor Name: ACN: (if applicable) ABN: (if applicable) Primary Contact Person: Postal Address: State: Postcode: Contact Details: Phone: : Fax: Part E – Well Details Well Set Name: Well Name: Eastings: Northings: