DA Form 1

        25) Applicant declaration
           By making this development application, I declare that all information in this development application is true and
           correct
           Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications
           from the assessment manager and any referral agency for the development application where written information
           is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001
        Note: It is unlawful to intentionally provide false or misleading information.
        Privacy – Personal information collected in this form will be used by the assessment manager and/or chosen
        assessment manager, any relevant referral agency and/or building certifier (including any professional advisers
        which may be engaged by those entities) while processing, assessing and deciding the development application.
        All information relating to this development application may be available for inspection and purchase, and/or
        published on the assessment manager’s and/or referral agency’s website.
        Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning
        Regulation 2017 and the DA Rules except where:
        • such disclosure is in accordance with the provisions about public access to documents contained in the Planning
             Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and
             Planning Regulation 2017; or
        • required by other legislation (including the Right to Information Act 2009); or
        • otherwise required by law.
        This information may be stored in relevant databases. The information collected will be retained as required by the
            Public Records Act 2002.


     PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
     USE ONLY

        Date received:                                         Reference number(s):

        Notification of engagement of alternative assessment manager
        Prescribed assessment manager
        Name of chosen assessment manager
        Date chosen assessment manager engaged
        Contact number of chosen assessment manager
        Relevant licence number(s) of chosen assessment
        manager

        QLeave notification and payment
        Note: For completion by assessment manager if applicable
        Description of the work
        QLeave project number
        Amount paid ($)                                                                  Date paid (dd/mm/yy)
        Date receipted form sighted by assessment manager
        Name of officer who sighted the form




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                                                                                                                DA Form 1 – Development application details
                                                                                                                              Version 1.6— 2 August 2024
Document Set ID: 23371843
Version: 1, Version Date: 26/11/2024