Get documents about "APPLICATION FOR DISTRICT PROSPECTING PERMIT
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APPLICATION FOR DISTRICT PROSPECTING PERMIT
Document Sample
PP No.
(Office Use Only)
Queensland Mines and Energy
Department of Employment, Economic Development and Innovation
www.dme.qld.gov.au ABN 24 830 236 406
APPLICATION FOR DISTRICT
PROSPECTING PERMIT
Section 21
OFFICIAL USE ONLY Mineral Resources Act 1989
PP No.
Form Number MRA-02 Version Number 3
PART A The completed original of this application and any attachments, must be submitted with the
Received AT Received BY prescribed fee at the Office of the Mining Registrar for the mining district in which the land is
situated.
The document submitted must first be accepted by the Mining Registrar as an application for a
DATE TIME prospecting permit under the provisions of section 81 of the Mineral Resources
Regulation 2003 before registration.
AM
/ / : PM Note: A document containing information that is false or misleading may attract a maximum
penalty of 200 penalty units.
PART B
If form is to be completed by hand please print clearly in ink and use block letters.
Document accepted as an
application for a district
Prospecting Permit in 1. APPLICANT DETAILS
accordance with section
81 of the Mineral
Resources Regulation Company Name/Surname 1.1
2003.
Given Name(s) 1.2
Mining Registrar
(SIGNATURE) ACN 1.3
DATE / /
FEE Paid RECEIPT no.
Address 1.4
PART C
ENTERED on register by Phone Number 1.5 ( )
(SIGNATURE) Fax Number 1.6 ( )
DATE / /
E-mail 1.7
GUIDE FOR
APPLICANTS
Only a single individual or company Specify Mining District 1.8
can apply for a parcel prospecting
permit.
Note: Once your application has been Specify which entitlements you are applying for:
submitted, an availability search of
the land will be completed. If there is
an existing mining claim, mineral
1.9 Pegging Purposes Prospecting/Hand Mining
development licence, or mining lease,
and you are not the holder, you will
need to obtain written consent from Types of mineral sought:
the relevant holder and submit it to
the Mining Registrar before the permit 1.10
can be considered.
Question 1.1
Specify company name or surname of
applicant.
2
2. SIGNATURE
GUIDE FOR
APPLICANTS I/We:
Question 1.2 solemnly sincerely and truly declare that the information provided in this form
Specify given name of applicant. is true and correct.
understand that any false or misleading information may attract a maximum
Question 1.3 penalty of 200 penalty units.
If company, what is the Australian
Company Number (ACN)?
Question 1.4, 1.5, 1.6 & 1.7 2.1 Signed at this day of , 20
Specify address, phone number, fax
number and email address of
applicant.
2.2 2.3
Question 1.8
State the district for which you are
applying.
Question 1.9
A Prospecting Permit may be Full name and title of Applicant Signature
conditioned to entitle the holder to peg
mining claims or mining lease, and/or
prospect, and/or hand mine.
2.4 2.5
Question 1.10
List the minerals you wish to prospect
for. Do not use symbols. Full name of Witness Signature of Witness
Please Note: the Government’s policy
is that it will not grant mining 3. ACCOMPANIMENTS
tenements for the purpose of mining
uranium in Queensland, nor will it 3.1 The following must accompany this form:
permit the treatment or processing of
uranium within the State. Tick
Question 2.1 • Proof of the applicant’s identity must be:
Insert full name of applicant.
o Where the applicant is an adult- a certified copy of the
Question 2.2 applicant’s birth certificate (not an extract of birth),
A company seal should endorse the passport, Card 18+ or driver’s licence; or
signature(s) of applicants authorised to
sign for their Companies where o Where the applicant is a company- a copy of the
applicable. certificate of registration issued by the Australian
Securities and Investments Commission (ASIC), the
Question 2.3
Enter the name of place where the company’s A.C.N.
application was signed, the day of the
month, the month and the year when
the form is signed.
• The prescribed application fee under the Mineral Resources
Regulation 2003
Question 3.1 – 3.2
Tick the appropriate boxes to indicate
compliance. 3.2 Department of Environment and Resource Management requirements:
Execution of Documents by
an Agent • Completed Application for an Environmental Authority
(Prospecting Permit)
If an agent or the holder of a power of
attorney is signing a document,
required to be lodged by an Act, on
behalf of another, the agent or holder
of the power of attorney must produce
current, written evidence of their
authority to act at the time of
lodgement.
A company signing an appointment of
agent or power of attorney must do so
in accordance with the corporation law
and/or the articles of association of the
company.
Disclaimer
The information provided on this form is used to assess the suitability of your application and maintain the public searchable register under the
Mineral Resources Act 1989 (‘the Act’). This information is authorised by sections 21 and 387 of the Act. Some or all of this information may be
provided to the Department of Environment and Resource Management for the issuing of an environmental authority, or through arrangements with
other government agencies authorised to make register searches, extracts or copies under section 387B of the Act. Your personal information will
not otherwise be disclosed to any other third party without your consent, unless authorised or required by law, or for the purposes of the Information
Privacy Act 2009.
