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Guideline | Template

Statements of corporate compliance, environmental performance history and financial capabilityFor grant, transfer or renewal applications(excluding small scale titles)

July 2019 | v1.5

More informationFor help with lodging this application, or for more information about authorisations in New South Wales, contact:Division of Resources and GeoscienceResource Operations Customer Assistance LinePhone +61 2 4063 6600 [email protected]

© State of New South Wales through the NSW Department of Planning, Industry and Environment. ABN: 20 770 707 468

This publication is copyright. You may download, display, print and reproduce this material providing that the wording is reproduced exactly, the source is acknowledged, and the copyright, update address and disclaimer notice are retained.

The information contained in this publication is based on knowledge and understanding at the time of writing. However, because of advances in knowledge, users are reminded of the need to ensure that information upon which they rely is up to date and to check currency of the information with the appropriate officer of the NSW Department of Planning, Industry and Environment or the user’s independent advisor.

Privacy statement

This information is collected by the Department of Planning, Industry and Environment (the department) for the purposes of assessing an application for an authorisation or associated with an authority as required by the Mining Act 1992, Mining Regulation 2016, Petroleum (Onshore) Act 1991 and Petroleum (Onshore) Regulation 2016.

This information may also be used by the department to confirm applicant details in the event that subsequent applications are made, and may also be used to establish and maintain databases to assist the department with its work generally.

Except for purposes required by law, the information will not be accessed by any third parties in a way that would identify the person without the consent of that person.

You may apply to the department to access and correct any information the department holds if that information is inaccurate, incomplete, not relevant or out of date.

NSW Department of Planning, Industry and Environment, Division of Resources and GeoscienceStatements of corporate compliance, environmental performance history and financial capability

When to use this formThe NSW Department of Planning, Industry and Environment, Division of Resources & Geoscience (the Division) assesses applications for activities to explore and extract the resources of the state of NSW for the benefit of the people of NSW. The NSW Resources Regulator (also within the department) is responsible for compliance and enforcement across exploration and mining activities in the state, including conducting assessments of applications.

To ensure that exploration licences, assessment leases and mining (or production) leases are held by individuals or companies that meet the objects of the Mining Act 1992 or the Petroleum (Onshore) Act 1991 the Division and the Resources Regulator require certain information in relation to individuals and companies making an application.

When assessing a grant, transfer or renewal application, the department requires the following from each applicant, or in the case of a transfer, each transferee:

a statement regarding corporate history (if applicable)

information about compliance record and environmental performance, and

a financial capability statement.

Document controlRM8 Reference: PUB16/544/DOI

Amendment scheduleDate Version # Amendment01 December 2016 1.0 Issued to replace Statement of financial capability PUB16/287

v5.1 September 2016 and Statement of corporate, compliance and environmental performance history v4, 11 November 2015

13 December 2016 1.1 Table 2.2, Table 2.3, Sections 3 and 4, Definitions

19 December 2016 1.2 Field formatting issues fixed

28 March 2017 1.3 Minor formatting fixes

22 June 2018 1.4 Departmental changes, Sections 3 and 4, Definitions

25 July 2019 1.5 Departmental changes


1 Applicant or transferee detailsThe department will obtain third party information on the applicant or transferee that is reasonably necessary for performing its functions.

Applicant or Transferee

A.C.N: (if applicable)

2 Company declaration

Note: Question 2 only applies to an applicant or transferee that is a Company.

Table 2.1: Current Officers of the applicant or transferee

Officer’s Name Role Date appointed

OR

Use the text box below to provide details of an ASIC search or note whether an extract is attached.

Table 2.2: List the name of the Ultimate Holding Company of the applicant (if applicable)

Details of Ultimate Holding Company Shares held (%)

Table 2.3: Related Body Corporate

List the names of the Related Body Corporate of the applicant (if applicable)

Related Body Corporate Name A.C.N.

PUB16/544/DOI Version 1.5, July 2019 3


3 Other declarations

The following declarations apply where the applicant or transferee is either an Individual or a Company. In the case of applicants or transferees who are a Company, the following declarations also apply to all current company officers.

Has the applicant or transferee:Been (either currently or within the last three years) associated with an approval authorisation for the exploration or production of coal, mineral or petroleum resources in any jurisdiction other than NSW? (Please note that this information is not required for an application of renewal).

Yes, I have included details of other jurisdictions below or attached details of the relevant jurisdictions other than NSW (if applicable).

No.

Not applicable to an application for renewal.

3.1 Compliance and environmental performance history3.1.1 In the last ten years, had an approval authorising exploration or production of coal, mineral or

petroleum resources, in any jurisdiction, refused, suspended, cancelled or revoked?

Yes No

3.1.2 In the last ten years, been subject to a prosecution under a provision of any Work Health and Safety legislation in any jurisdiction or have the charges currently pending?

Yes No

3.1.3 In the last ten years, been convicted of an offence under a provision of the Mining Act 1992, Protection of the Environment Operations Act 1997 or other relevant legislation in any jurisdiction, as set out in Schedule 5 of Mining Regulation 2016 or have charges currently pending?

Yes No

3.1.4 In the last ten years, had a licence or other authority suspended or revoked under the Protection of the Environment Operations Act 1997 (NSW)?

Yes No

3.1.5 In the last ten years, paid a penalty under a penalty notice for an offence under the Mining Act 1992, Protection of the Environment Operations Act 1997, Work Health and Safety legislation or other relevant legislation (NSW jurisdiction only) as set out in Schedule 5 of Mining Regulation 2016?

Yes No

3.1.6 In the last ten years, been subject to an agreed enforceable undertaking, pursuant to the Mining Act 1992, the Petroleum (Onshore) Act 1991, Protection of the Environment Operations Act 1997, Work Health and Safety Act 2011 or other relevant legislation as set out in Schedule 5 of Mining Regulation 2016?

Yes No



3.2 Financial history information 3.2.1 Been convicted under the Proceeds of Crime Act 2002 (Commonwealth) or under the Crimes

Legislation Amendment (Serious and Organised Crime) Act 2010 (Commonwealth), or for offences of money laundering, terrorism financing or corruption under any Commonwealth or State Act, or have charges currently pending?

Yes No

3.2.2 Been convicted in New South Wales or elsewhere for a serious offence involving fraud or dishonesty that was recorded in the last 10 years, or have charges currently pending?

Yes No

3.2.3 Been convicted in New South Wales or elsewhere for a serious offence relating to the management of a company, recorded within the last five years, or have charges currently pending?

Yes No

3.2.4 Been a director or officer of a company that has been wound up,is the subject of a winding up order or for which a receiver, receiver and manager, controller or administrator has been appointed under the Corporations Act 2001 (Commonwealth), during the last three years?

Yes No

3.2.5 Been an undischarged bankrupt or applied to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounded with his or her creditors or made an assignment of his or her remuneration for their benefit, during the last three years?

Yes No

3.2.6 Been disqualified from holding office in a company under any law of New South Wales or any other State or Territory or the Commonwealth, during the last 3 years?

Yes No

I certify that the information provided is true and correct to the best of my knowledge and belief. I understand under the Crimes Act 1900 NSW Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence; and under the Mining Act 1992 s378c and under the Petroleum (Onshore) Act 1991 s125D, 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.

Name: Signature:

Position:

Date:

If you have answered ‘Yes’ to any of the questions in Section 3.1 or 3.2, please ensure you attach a separate statement setting out the specific circumstances of the history and stating reasons why you think those circumstances should not prevent you from holding a title.

NOTE: The person providing the separate statement must ensure that their statement includes a certification as to the information being true and correct in the following terms:

I certify that the information provided is true and correct to the best of my knowledge and belief. I understand under the Crimes Act 1900 NSW Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence; and under the Mining Act 1992 s378c and under the Petroleum (Onshore) Act 1991 s135, 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.



4 Statement of financial capabilityThis section outlines the information required to support a grant, renewal or transfer in accordance with the Mining Act 1992 or the Petroleum (Onshore) Act 1991 for the assessment of the applicant’s or transferee’s (in the case of a transfer) financial capability to carry out the proposed work programs.

The statement of financial capability is to be completed by the applicant or transferee (not an agent).

In the case of a natural person — the applicant (or for a transfer, the transferee) completes the statement.

In the case of a Company— a Company Secretary or Director of the applicant company (or for a transfer, the transferee) completes this statement.

STATEMENT

Enter applicant or transfereeEnter addressEnter city state postcode

I confirm that as at the date of the application there are reasonable grounds to believe that that the planned expenditure can be financed for the term of the work program or operations.

In establishing reasonable grounds that the planned expenditure can be met for the term of the work program I have had regard for the following:1. the work program or operations2. all other current and proposed commitments3. current assets and liabilities

I, as at the date of the application, am not aware of any other financial commitments which may negatively impact upon the commitment to complete the term of the work program.I certify that the information provided in this application is true and correct. I understand that under the Crimes Act 1900 Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence; and under the Mining Act 1992 s378c and under the Petroleum (Onshore) Act 1991 s125D, 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.

I also acknowledge that NSW Department of Planning, Industry and Environment will take into consideration assessments and financial information provided by third parties. I understand that where adverse material is identified, I may be required to produce detailed financial information at my (or the applicant/company’s) expense.

Signed

Insert name

Insert position

Insert date



DefinitionsTerm Meaning

Current or other proposed commitmentsRefer to Accounting Standard AASB 101 Presentation or Financial Statements published by the Australian Accounting Standards Board

Current Commitment

According to Chartered Accountants Australia for the purposes of the accounting standards, entities may recognise liabilities (a present obligation of the entity arising from past events, the settlement of which is expected to result in an outflow of resources embodying economic benefits to the entity) or provisions (a liability where the timing or amount of the expected outflow is uncertain) in their financial statements. Proposed Commitment

They must also disclose (but do not include in the statement of financial position/balance sheet) contingent liabilities which are either possible obligations whose existence will be confirmed by future events or present obligations which cannot be measured reliably or for which it is not probable that the obligation will be settled).

Current assets and current liabilities Refer to Accounting Standard AASB 101 Presentation or Financial Statements published by the Australian Accounting Standards Board

Current AssetsAn entity shall classify an asset as current when: (a) it expects to realise the asset, or intends to sell or consume it, in its normal operating cycle; (b) it holds the asset primarily for the purpose of trading; (c) it expects to realise the asset within twelve months after the reporting period; or(d) the asset is cash or a cash equivalent (as defined in AASB 107) unless the asset is restricted from being exchanged or used to settle a liability for at least twelve months after the reporting period. An entity shall classify all other assets as non-currentCurrent LiabilitiesAn entity shall classify a liability as current when: (a) it expects to settle the liability in its normal operating cycle;(b) it holds the liability primarily for the purpose of trading; (c) the liability is due to be settled within twelve months after the reporting period; or (d) it does not have an unconditional right to defer settlement of the liability for at least twelve months after the reporting period (see paragraph 73 of AASB101). Terms of a liability that could, at the option of the counterparty, result in its settlement by the issue of equity instruments do not affect its classification.

Environmental performance licence or other authority

includes a consent, licence or permission or any form of authorisation

Minerals As defined in Schedule 1 of Mining Regulation 2016 (NSW)

Officer (and Company Officer) Refer to section 9 of the Corporations Act 2001 (Cth) limited to;(a) director or secretary of the corporation; or (b) a person: (i) who makes, or participates in making, decisions that affect the whole, or a substantial part, of the business of the corporation; or (ii) who has the capacity to affect significantly the corporation's financial standing

Other relevant legislation Defined in Schedule 5 of the Mining Regulation 2016:Commonwealth legislationEnvironment Protection and Biodiversity Conservation Act 1999Offshore Minerals Act 1994Offshore Petroleum and Greenhouse Gas Storage Act 2006Offshore Petroleum (Royalty) Act 2006New South Wales legislationDams Safety Act 1978Dams Safety Act 2015Environmental Planning and Assessment Act 1979Fisheries Act 1935Fisheries Management Act 1994Heritage Act 1977



Term Meaning

Local Government Act 1993Marine Estate Management Act 2014Marine Pollution Act 2012Mining Act 1992National Parks and Wildlife Act 1974Native Vegetation Act 2003Offshore Minerals Act 1999Petroleum (Offshore) Act 1982Petroleum (Onshore) Act 1991Soil Conservation Act 1938Threatened Species Conservation Act 1995Uranium Mining and Nuclear Facilities (Prohibitions) Act 1986Water Act 1912Water Management Act 2000Water NSW Act 2014Western Lands Act 1901Northern Territory legislationEnvironmental Assessment ActEnvironmental Offences and Penalties ActHeritage ActMining Management ActPetroleum ActPetroleum (Submerged Lands) ActPlanning ActWaste Management and Pollution Control ActWater ActQueensland legislationAboriginal Cultural Heritage Act 2003Environmental Protection Act 1994Geothermal Energy Act 2010Greenhouse Gas Storage Act 2009Mineral Resources Act 1989Nature Conservation Act 1992Offshore Minerals Act 1998Petroleum Act 1923Petroleum (Submerged Lands) Act 1982Regional Planning Interests Act 2014Queensland Heritage Act 1992Vegetation Management Act 1999Water Act 2000South Australian legislationAboriginal Heritage Act 1988Development Act 1993Environment Protection Act 1993Heritage Places Act 1993Mining Act 1971National Parks and Wildlife Act 1972Native Vegetation Act 1991Natural Resources Management Act 2004Offshore Minerals Act 2000Opal Mining Act 1995Petroleum and Geothermal Energy Act 2000Petroleum (Submerged Lands) Act 1982River Murray Act 2003South Eastern Water Conservation and Drainage Act 1992



Term Meaning

Water Industry Act 2012

Tasmanian legislationAboriginal Relics Act 1975Environmental Management and Pollution Control Act 1994Historic Cultural Heritage Act 1995Land Use Planning and Approvals Act 1993Mineral Resources Development Act 1995National Parks and Reserves Management Act 2002Nature Conservation Act 2002Petroleum (Submerged Lands) Act 1982Pollution of Waters by Oil and Noxious Substances Act 1987Threatened Species Protection Act 1995Water Management Act 1999Victorian legislationEnvironment Protection Act 1970Extractive Industries Development Act 1995Flora and Fauna Guarantee Act 1988Geothermal Energy Resources Act 2005Greenhouse Gas Geological Sequestration Act 2008Mineral Resources (Sustainable Development) Act 1990National Parks Act 1975Petroleum Act 1998Petroleum (Submerged Lands) Act 1982Planning and Environment Act 1987Pollution of Waters by Oil and Noxious Substances Act 1986Underseas Mineral Resources Act 1963Water Act 1989Wildlife Act 1975Western Australian legislationAboriginal Heritage Act 1972Conservation and Land Management Act 1984Contaminated Sites Act 2003Environmental Protection Act 1986Heritage of Western Australia Act 1990Mining Act 1978Offshore Minerals Act 2003Petroleum and Geothermal Energy Resources Act 1967Petroleum (Submerged Lands) Act 1982Planning and Development Act 2005Pollution of Waters by Oil and Noxious Substances Act 1987Rights in Water and Irrigation Act 1914Wildlife Conservation Act 1950

Serious offence An offence committed in New South Wales that is punishable by imprisonment for life or for a term of 5 years or more or by a fine of $500,000 or more, or an offence committed elsewhere than in New South Wales that if committed in New South Wales would be an offence so punishable, orAn offence committed under a law of the Commonwealth that is punishable by imprisonment for life or for a term of 5 years or more or by a fine of $500,000 or more.

Related Body Corporate Refer to section 50 of the Corporations Act 2001 (Cth) limited toWhere a body corporate is:(a) a holding company of another body corporate; or(b) a subsidiary of another body corporate

Ultimate Holding Company Has the same meaning as defined by the Corporations Act 2001 (Cth). An ultimate holding company must be the holding company of another, and must not be a subsidiary of any other company.


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