Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 1

Registration of interest application form To make an application for a right to apply for an aquifer access licence under the Controlled Allocation Order (Various Groundwater Sources) 2021 (Order), you must first lodge this Registration of Interest (RoI) application form.

Checklist Before filling out this form

Read the Controlled Allocation Order (Various Groundwater Sources) 2021 (Order) including the Terms and Conditions set out in Schedule 2. By submitting this application, you are accepting the Terms and Conditions.

Contact WaterNSW (1300 662 077) to determine which groundwater source and water management zone (where applicable) applies to you.

Download the Registration of Interest Application Guide for reference when filling out this form. The Guide includes step-by step instructions for completing this form and information on how to pay the application fee.

Filling out this form

Applicants applying as an individual to complete Section A: A1-A13 (ensure you mark who is theauthorised contact person and if you are 18 years of age or over), Section B & C, and Section D: D1-D5.

Applicants applying as a company registered with ASIC to complete Section A: A14-A33, Section B &C, and Section D: D6-D14 (two signatures are required if you are signing as a Director of a company (thatis not a Sole Director) or a Company Secretary).

Applicants applying as a legal entity other than an individual or company registered with ASIC tocomplete Section A: A34-A57, Section B & C, and Section D: D15-D23.

Attachments to support application

If you have signed on behalf of a company registered with ASIC, or other legal entity as a dulyauthorised officer or power of attorney attach evidence to your application that you are the duly authorisedofficer or power of attorney.

If you are applying as a legal entity other than a registered company, provide any supporting evidencethat you are a legal entity.

Privacy note

The personal information you provide in this form will be treated in accordance with the Privacy and Personal Information Protection Act 1998, under which

you have rights of access and correction. Your personal information will be used by DPIE Water for assessing and processing your ROI Application or in

connection with the application for, or operation of, any access licence granted following the ROI process and may be disclosed to State or Commonwealth

public authorities, including WaterNSW and NRAR, and other parties: (i) for any of the above mentioned purposes; (ii) for research related purposes; or (iii)

as required by law. It may be used from time to time to contact you about services DPIE Water provides. Further information regarding privacy can be

obtained from the NSW Department of Planning, Industry and Environment website at: www.dpie.nsw.gov.au/privacy

FOR OFFICE

USE ONLY

Date received Application fee

ASIC Company name check RoI number

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 2

Terms and Conditions Before making a registration of interest (RoI) application, you must read the 'Terms and Conditions for the Controlled Allocation Process' set out in Schedule 2 of the Order (Terms and Conditions). The registration of interest process will be conducted in accordance with the Terms and Conditions. The Terms and Conditions set out the rights and obligations of each participant. By submitting a RoI application, you are accepting the Terms and Conditions.

Important information • You are advised to read the Order (including the Terms and Conditions) and the 'Guide to registering

your interest in the controlled allocation process' (the Guide). The Guide includes step-by step instructions for completing each section of this RoI application form.

• The Guide explains how to pay the RoI application fee.• Applicants may choose to sign the RoI form electronically and submit via email or sign the by hand

and submit via post.• The NSW Department of Planning, Industry and Environment may request more information about

your RoI application.

How to submit a RoI application You must submit the registration of interest application form by 30 November 2021 at 5pm.

Electronic submissions to: controlled.allocation@dpie.nsw.gov.au

Postal submissions to: Controlled Allocation Officer (Celia Moloney) NSW DPIE Water Locked Bag 5022 Parramatta NSW 2124

Please note:

• The department will confirm via email when your application has been received. If you do not receive a confirmation email from the department within two business days of submitting via email or five business days of submitting via post, contact the Controlled Allocation Helpdesk. Email: controlled.allocation@dpie.nsw.gov.au

Submissions via post

• It is recommended to express post or register your post in case your application goes missing. The department will only accept applications that are received.

• Your application will not be accepted unless there is evidence it was sent before the 30 November 2021 at 5pm. It is recommended that you either:

o Submit your application so that it is received before 30 November 2021 at 5pm.o Post your application over the counter at a post office instead of by depositing in a post

collection box (post placed in post collection boxes may not be stamped or processed till the next day).

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 3

Section A: Applicant details

Applicant details

A1 Applicants applying as an individual – including sole traders, individuals on behalf of a partnership, trustees on behalf of a trust

APPLICANT 1 A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 2 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 3 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 4 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 4

A1 Applicants applying as an individual (continued)

APPLICANT 5 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 6 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 7 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

APPLICANT 8 (optional) A2 Title A3 Family name A4 Given name

A5 Postal address A6 Town

A7State A8 Postcode A9 Country

A10 Phone number A11 Email A12 Mark if authorised contact person A13 Mark if you are ≥18 years of age

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 5

A14 Applicants applying as a company registered with ASIC

A15 Company legal name A16 Nature of company business/activities A17 ACN

A18 Registered office address A19 Town

A20 State A21 Postcode A22 Country

A23 Preferred postal address (if not the same as the registered office address) A24 Town

A25 State A26 Postcode A27 Country

Authorised contact person A28 Title A29 Family name A30 Given name

A31 Position A32 Phone number A33 Email

A34 Applicants applying as a legal entity other than an individual or registered company

A35 Legal entity name A36 Entity type A37 Nature of entity business/activities

A38 Does the legal entity have an ABN, ACN or ARBN? (Mark the appropriate box)

Yes, please provide ABN, ACN, or ARBN No

A39 ABN (if available) A40 ACN (if available) A41 ARBN (if available)

A42 Registered office address, or if not available a principal place of business address A43 Town

A44 State A45 Postcode A46 Country

A47 Preferred postal address (if not the same as the address provided above) A48 Town

A49 State A50 Postcode A51 Country

Authorised contact person A52 Title A53 Family name A54 Given name

A55 Position A56 Phone number A57 Email

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 6

Section B: Nominated price per unit share of water The minimum price per unit of access licence share (unit share) of water in each water source is set out in Schedule 1 of the Order.

Note: Your application will be invalid if you nominate a price lower than the relevant minimum price.

B1 Nominate the price per unit share of water you are willing to pay for the right to apply for an access licence (insert whole

dollar amount only)

$

Section C: Nominated number of unit shares to purchase Please nominate the number of unit shares you are seeking the right to apply for.

C1 Nominate the number of unit shares of water you want to purchase (insert whole numbers only) Unit Shares

C2 Name of water source

C3 Management zone in the water source (if applicable)

C4 Name of town nearest to where you propose to take this water

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 7

Section D: Acknowledgement of applicant(s)Each applicant must sign the completed RoI application form.

DECLARATION:

I/We hereby confirm that the information provided in this application is true and accurate.

By signing this declaration, I/we accept and agree to the Terms and Conditions. D1 Applicants signing declaration as an individual

D2 Full name of Applicant 1 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name Applicant 2 (optional) D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 3 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 4 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 5 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 6 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 7 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

D2 Full name of Applicant 8 D3 Signature D4 Date

D5 Do you agree to the use of electronic signatures to execute this document?

Yes, print, sign, scan and submit via email or sign electronically and submit via email No, print, sign and submit via post

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 8

D6 Applicants signing declaration as a company

Executed on behalf of ________________________________________ in accordance with section 127 of the Corporations Act 2001 Name of company

By _________________________________________________ Name of signatory

By (if required) _______________________________________ Name of signatory

D7 Signature D11 Signature

D8 Date D12 Date (if required)

D9 Position Sole director, only one signature required Director, must co-sign with another company director orcompany secretary Power of attorney, only one signature required and mustprovide supporting evidence

D13 Position (if required) Director Company secretary

D10 Do you agree to the use of electronic signatures to execute this document? Yes, print, sign, scan and submit via email or signelectronically and submit via email No, print, sign and submit via post

D14 Do you agree to the use of electronic signatures to execute this document? (If required) Yes, print, sign, scan and submit via email or signelectronically and submit via email No, print, sign and submit via post

D15 Applicants signing declaration as a legal entity other than an individual or registered company

Executed on behalf of _______________________________________________________________________________________ Name of legal entity

By _________________________________________________ Name of signatory

By (optional) _______________________________________ Name of signatory

D16 Signature D20 Signature (optional)

D17 Date D21 Date (optional)

D18 Position D22 Position (optional)

D19 Do you agree to the use of electronic signatures to execute this document? Yes, print, sign, scan and submit via email or signelectronically and submit via email No, print, sign and submit via post

D23 Do you agree to the use of electronic signatures to execute this document? Yes, print, sign, scan and submit via email or signelectronically and submit via email No, print, sign and submit via post

Registration of Interest Application 2021 Application form

NSW Department of Planning, Industry and Environment | PUB21/591 | 9

Feedback

How did you receive notice of the registration of interest period? (select as many options as relevant)

The Land newspaper

The Sydney Morning Herald newspaper

The Daily Telegraph newspaper

Controlled allocations website

Media release on the Department of Planning Industry and Environment website

Email

Department of Planning Industry and Environment newsletter

Local Land Services newsletter

Biodiversity Conservation Trust newsletter

WaterNSW newsletter

Other

If you selected ‘other’ please specify:

Please provide any feedback, suggestions to improve this form and/or the application guide (optional).

© State of New South Wales through Department of Planning, Industry and Environment 2021. The information contained in this publication is based on knowledge and understanding at the time of writing (October 2021). However, because of advances in knowledge, users are reminded of the need to ensure that the information upon which they rely is up to date and to check the currency of the information with the appropriate officer of the Department of Planning, Industry and Environment or the user’s independent adviser.