No. I will provide outstanding information within 10 business days of lodging this application. Declaration This form should be signed by the applicant/s (in the case of a company a duly authorised officer) or an agent authorised to act on behalf of the applicant/s. I/We declare that the information provided in this application is true and correct. I/We understand that under of the Crimes Act 1900, knowingly giving false or misleading information is a serious offence; and under of the Mining Act 1992 any person who provides information that the person knows to be false or misleading is guilty of an offence, for which they may be subject to prosecution. Applicant/s Name Date Signature Name Date Signature Name Position/title Date Signature OR authorised to act for this applicant/s Evidence of appointment is required if this has not been previously supplied to the department. Name
No. I will provide outstanding information within 10 business days of lodging this application. Declaration This form should be signed by the applicant/s (in the case of a company a duly authorised officer) or an agent authorised to act on behalf of the applicant/s. I/We declare that the information provided in this application is true and correct. I/We understand that under of the Crimes Act 1900, knowingly giving false or misleading information is a serious offence; and under of the Mining Act 1992 any person who provides information that the person knows to be false or misleading is guilty of an offence, for which they may be subject to prosecution. Applicant/s Name Date Signature Name Date Signature Name Position/title Date Signature OR authorised to act for this applicant/s Evidence of appointment is required if this has not been previously supplied to the department. Name
AL1-Assessment-lease-application-.docx