form 5 amended

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 6

Planning Act Form 5 - Change application form

Version 1.2 — 7 February 2020