DA Form 1

• 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 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
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 1.1— 22 JUNE 2018