DAForm1_AttachmenttoEA.01_signed

                                                                                                 Application form
            Development application Form 1 - Application details—attachment for an
                                         application for an environmental authority

Attachment 1
Joint applicants and appointment of principal applicant
We are joint applicants for this environmental authority application and hereby appoint                          as the
principal applicant to receive statutory documents relating to this application.
  Name - individual or contact person if applicant is an organisation*           Suitable Operator Reference Number*


  Organisation name, including trading name (*if an organisation)                ABN/ACN (*if an organisation)


  Residential or registered business address (not a post office box)*            Phone*


  Postal address (if same as above, state “AS ABOVE”) *                          Facsimile


  Email*                                                                                 Indicate if you want to receive
                                                                                         correspondence via email

  Signature*                                                                     Date*



  Name - individual or contact person if applicant is an organisation*           Suitable Operator Reference Number*


  Organisation name including trading name (*if an organisation)                 ABN/ACN (*if an organisation)


  Residential or registered business address (not a post office box)*            Phone*


  Postal address (if same as above, state “AS ABOVE”)*                           Facsimile


  Email*                                                                                 Indicate if you want to receive
                                                                                         correspondence via email

  Signature*                                                                     Date*



  Name - individual or contact person if applicant is an organisation*           Suitable Operator Reference Number*


  Business name including trading name (*if an organisation)                     ABN/ACN (*if an organisation)


  Residential or registered business address (not a post office box) *           Phone*


  Postal address (if same as above, state “AS ABOVE”)*                           Facsimile


  Email*                                                                                 Indicate if you want to receive
                                                                                         correspondence via email

  Signature*                                                                     Date*




Page 11 of 12 • ESR/2015/1791 • Version 8.00 • Last reviewed: 12 AUG 2021     Department of Environment and Science