DECLARATION I, , the applicant for this permit, declare that the information in this application is correct to the best of my knowledge AND that I and all of the proposed permit holders have read and understand all of the standard permit conditions enclosed AND that neither I nor any of the proposed permit holders have been convicted1 of, or are subject to proceedings for, an offence under: the EPBC Act or Regulations; or another law of the Commonwealth or a State or Territory about the protection, conservation or management of native species or ecological communities; or section 62 of the Crimes Act 1914 or sections 11.1. 11.4 or 11.53 of the Criminal Code, in relation to an offence under a law mentioned in a) or b) above; or a provision of a law of a State or Territory that is equivalent to a provision mentioned in c) above. 1 Part VIIC of the Crimes Act 1914 includes provisions that, in certain circumstances, relieve persons from the requirement to disclose spent convictions and require persons aware of such convictions to disregard them. The applicant is taken to have been convicted of an offence if, within five years before the application is made, the applicant: has been charged with, and found guilty of, the offence but discharged without conviction; or has not been found guilty of the offence, but a court has taken the offence into account in passing sentence on the applicant for another offence. 2 Section 6 of the Crimes Act 1914 deals with being an accessory after the fact. 3 Sections 11.1, 11.4 and 11.5 of the Criminal Code deal with attempts to commit offences, inciting to or urging the commission of offences by other people and conspiracy to commit offences. Name of applicant Position Signature of applicant Date In the presence of: Name of witness The witness must be at least 18 years of age Signature of witness Date Send this application to: The Director Queensland South and Sea Dumping Section Assessments and Governance Branch Environmental Standards Division GPO Box 787 CANBERRA ACT 2601 or email to
DECLARATION I, , the applicant for this permit, declare that the information in this application is correct to the best of my knowledge AND that I and all of the proposed permit holders have read and understand all of the standard permit conditions enclosed AND that neither I nor any of the proposed permit holders have been convicted1 of, or are subject to proceedings for, an offence under: the EPBC Act or Regulations; or another law of the Commonwealth or a State or Territory about the protection, conservation or management of native species or ecological communities; or section 62 of the Crimes Act 1914 or sections 11.1. 11.4 or 11.53 of the Criminal Code, in relation to an offence under a law mentioned in a) or b) above; or a provision of a law of a State or Territory that is equivalent to a provision mentioned in c) above. 1 Part VIIC of the Crimes Act 1914 includes provisions that, in certain circumstances, relieve persons from the requirement to disclose spent convictions and require persons aware of such convictions to disregard them. The applicant is taken to have been convicted of an offence if, within five years before the application is made, the applicant: has been charged with, and found guilty of, the offence but discharged without conviction; or has not been found guilty of the offence, but a court has taken the offence into account in passing sentence on the applicant for another offence. 2 Section 6 of the Crimes Act 1914 deals with being an accessory after the fact. 3 Sections 11.1, 11.4 and 11.5 of the Criminal Code deal with attempts to commit offences, inciting to or urging the commission of offences by other people and conspiracy to commit offences. Name of applicant Position Signature of applicant Date In the presence of: Name of witness The witness must be at least 18 years of age Signature of witness Date Send this application to: The Director Queensland South and Sea Dumping Section Assessments and Governance Branch Environmental Standards Division GPO Box 787 CANBERRA ACT 2601 or email to
protected-species-application-form.docx