Amended DA Form 1

PART 9 - FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE
USE ONLY

Date received: __ — '| Reference number(s): |

Notification of engagement of alternative assessment manager
| 1

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 (dd/mm/yy) |
Date receipted form sighted by assessment manager

 

 

 

 

 

 

 

Name of officer who sighted the form

Page 12
DA Form 1 — Development application details
Version 1.3— 28 September 2020