DA Form 1

development permit is issued (see 21)                                                                                        Not applicable

25) Applicant declaration
      By making this development application, I declare that all information in this development application is true and
      correct
      Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications
      from the assessment manager and any referral agency for the development application where written information is
      required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001
Note: It is unlawful to intentionally provide false or misleading information.

Privacy – Personal information collected in this form will be used by the assessment manager and/or chosen
assessment manager, any relevant referral agency and/or building certifier (including any professional advisers which
may be engaged by those entities) while processing, assessing and deciding the development application.
All information relating to this development application may be available for inspection and purchase, and/or published
on the assessment manager’s and/or referral agency’s website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017
and the DA Rules except where:
 • such disclosure is in accordance with the provisions about public access to documents contained in the Planning
      Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and
      Planning Regulation 2017; or
 • required by other legislation (including the Right to Information Act 2009); or
 • otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the
Public Records Act 2002.


PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER - FOR
OFFICE USE ONLY
Date received:                                              Reference number(s):


Notification of engagement of alternative assessment manager
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




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                                                                                                        DA Form 1 - Development application details
                                                                                                                       Version 1.6 - 2 August 2024