IDAS form 1 · OPW12/0427

Privacy-the information coltected in this form will be used by the Department of lnfrastructure and Planning (DlP) in
accordance with the processing and assessment of your application. Your personal detaits will not be disclosed for a purpose
outside of the IDAS process, exceptwhere required by legislation (includingthe Rightto lnformationActzoog) oras required
by Parliament. This information may be stored in a departmental database. The information collected will be retained as
required by lhe Public Records Act zooz.



OFFICE USE ONLY
 Date received                                             Reference numbers


NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER
 To                                        Council. I have been engaged as the private certifier for the buitding work referred
                                           to in this application


                                                                                                          Buitding
Date of engagement        Name                                         BSA Certification license number
                                                                                                          classification/s




QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certitier it applicable)
                                                                                        Date receipted
                                 Qleave Project          Amount paid                    form sighted by Name of officer who
Description of the work                                                    Date paid
                                 Number                  ($)                            assessment      sighted the form
                                                                                        manager




 The Sustainable PlanningAct zoog(SPA) is administered by the Department of lnfrastructure and Planning. This form and
 all other required application materials should be sent to your assessment manager and any referral agencies.


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