3737idas-form-01

12. Is the payment of a portable long service leave levy applicable to this application? (Refer to notes at the end
of this form for more information.)

         No—go to question 14                Yes


13. Has the portable long service leave levy been paid? (Refer to notes at the end of this form for more
information.)

         No
         Yes—complete Table N and submit with this application the yellow local government/private certifier’s copy of the
         receipted QLeave form

Table N

Amount paid               Date paid          QLeave project number (6 digit number starting with A, B, E, L or P)
                          (dd/mm/yy)




14. Has the local government agreed to apply a superseded planning scheme to this application under section
96 of the Sustainable Planning Act 2009?

         No
         Yes—please provide details below

Name of local government                           Date of written notice given     Reference number of written notice given
                                                   by local government              by local government (if applicable)
                                                   (dd/mm/yy)




    15. List below all of the forms and supporting information that accompany this application (Include all IDAS
    forms, checklists, mandatory supporting information etc. that will be submitted as part of this application. Note: this
    question does not apply for applications made online using Smart eDA.)

Description of attachment or title of attachment                                              Method of lodgement to
                                                                                              assessment manager

IDAS Form 5                                                                                   Email

Planning Report including plans of the development                                            Email




    16. Applicant’s declaration

   By making this application, I declare that all information in this application is true and correct (Note: it is unlawful to
provide false or misleading information.)




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