DA form 1

PART 9 – 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
  Date receipted form sighted by assessment manager
  Name of officer who sighted the form

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.




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                                                                                    DA Form 1 – Development Application details
                                                                                                      Version 1.0—3 July 2017