Application Form

PART 8 —-FOR COMPLETION OF THE ASSESSMENT MANAGER -— FOR OFFICE

USE ONLY

 

Date received: [sid Reference number(s): |

QLeave notification and payment

 

 

Note: For completion by assessment manager if applicable

Description of the work

 

QLeave project number

 

Amount paid ($) l

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