Given name/s B3 Company/corporation name (if applicable) B4 ACN (if applicable) Position held (if applicable) B5 B6 Address B7 Town State Postcode Country B8 B9 B10 B11 Phone Mobile phone B12 B13 Fax Email B14 B15 SECTION C: Controlled allocation details Provide the Reference Number for your right to apply for a new access licence under section 65 of the pursuant to which this application is being made, and the details of the new Water Management Act 2000 access licence you are applying for. Reference Number: C1 Name of water source C2 Name of water management zone (if applicable) C3 Number of unit shares C4 SECTION D: Water access licence tenancy Tick the appropriate box to describe the tenancy of applicants listed in Section A. Licence to be held by: sole holder joint tenants tenants in common* D1 * If the water access licence is to be held by Tenants in Common, specify details: Name to hold fraction of licence D2 Name to hold fraction of licence D3 If there are more than two applicants, photocopy/print multiple copies of this page. Have extra copies of this page been attached? No Yes - specify number: D4 SECTION E: Declaration of applicant(s) Declaration of applicants Each applicant listed in Section A must (“Applicants”) agree to the declaration below, and sign the application form. If there are more applicants than spaces provided on the following pages, attach extra copies of page 4 (for individuals) or page 5 (for corporations) as required.
B3 Given name/s B4 Company/corporation name (if applicable) B5 ACN (if applicable) B6 Position held (if applicable) B7 Address B8 Town B9 State B10 Postcode B11 Country B12 Phone B13 Mobile phone B14 Fax B15 Email SECTION C: Controlled allocation details Provide the Reference Number for your right to apply for a new access licence under section 65 of the Water Management Act 2000 pursuant to which this application is being made, and the details of the new access licence you are applying for. C1 Reference Number: C2 Name of water source C3 Name of water management zone (if applicable) C4 Number of unit shares SECTION D: Water access licence tenancy Tick the appropriate box to describe the tenancy of applicants listed in Section A. D1 Licence to be held by: sole holder joint tenants tenants in common* * If the water access licence is to be held by Tenants in Common, specify details: D2 Name to hold fraction of licence D3 Name to hold fraction of licence If there are more than two applicants, photocopy/print multiple copies of this page. D4 Have extra copies of this page been attached? No Yes - specify number: SECTION E: Declaration of applicant(s) Declaration of applicants Each applicant listed in Section A (“Applicants”) must agree to the declaration below, and sign the application form. If there are more applicants than spaces provided on the following pages, attach extra copies of page 4 (for individuals) or page 5 (for corporations) as required.