IDAS Form 1

NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER
 To                                                 Council. I have been engaged as the private certifier for the
                                                    building work referred to in this application

                                                                BSA Certification license          Building
Date of engagement Name
                                                                number                             classification/s




QLEAVE NOTIFICATION AND PAYMENT (For completion by assessment manager or private certifier if
applicable.)
                                                                  Date receipted
                        QLeave project Amount paid                form sighted by Name of officer who
Description of the work                                 Date paid
                        number         ($)                        assessment      sighted the form
                                                                  manager




The Sustainable Planning Act 2009 is administered by the Department of State Development, Infrastructure and
Planning. This form and all other required application materials should be sent to your assessment manager and any
referral agencies.




8                                                                                           IDAS form 1—Application details
                                                                                              Version 2.0 17 December 2012