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PART 8 — FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE
USE ONLY

 

Date received: | Reference number(s): |

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

 

Page 5
Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020