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					                                                                                                      MC/ML/MDL


                                                                                                               (Office Use Only)
                                                                         Department of Employment, Economic Development and Innovation
                                                                                                                                Mines
                                                                                                             www.deedi.qld.gov.au   ABN 24 830 236 406




                                                   SURRENDER
                                                      Sections 107, 210, 309
                                                    Mineral Resources Act 1989
                                               Form Number MRA-21 Version Number 2

  OFFICIAL USE ONLY
MC/MDL/ML No.
                                          The original completed document and any attachments must be submitted with the prescribed
                                          fee at the Office of the Mining Registrar for mining claims or mining leases, or at the Office of
          PART A
                                          the Chief Executive for mineral development licences.
Received AT   Received BY
                                          If form is to be completed by hand please print clearly in ink and use block letters.

                                          Note: A document containing information that is false or misleading may attract a maximum
       DATE              TIME             penalty of 200 penalty units.
                                AM
   /     /               :      PM        1.     HOLDER DETAILS
              PART B                       Company Name/Surname                1.1
   FEE Paid       RECEIPT no.

                                           Given Name(s)           1.2

        PART C
                                           ACN (if company)        1.3                                  Percentage          1.4                     %
ENTERED on register by

                                           Company Name/Surname                1.1
(SIGNATURE)

                                           Given Name(s)           1.2
DATE           /     /
                                           ACN (if company)        1.3                                  Percentage          1.4                     %
GUIDE FOR
APPLICANTS
                                           Company Name/Surname                1.1
This form is to be used where a
person seeks to surrender a mining
claim, mining lease or a mineral           Given Name(s)           1.2
development license.

The Mineral Resources Act 1989             ACN (if company)        1.3                                  Percentage          1.4                     %
requires Improvement Restorations to
be conducted on any surrendered
mining tenement. Section 6C defines        Company Name/Surname                1.1
“improvement restoration” as
repairing any damage caused by an
activity under the tenement to all pre-    Given Name(s)           1.2
existing improvements on, or
attached to, the land subject to the
tenement.
                                           ACN (if company)        1.3                                  Percentage          1.4                     %
Question 1.1 – 1.4
Specify holder details including                                                                Total Percentage            1.5                     %
Australian Company Number (ACN)
where applicable and percentage of
interest held.

Question 1.5
The total interest must equal 100%. If
you are entering these details online,
right click the ‘0’ and select ‘Update
Field’.
                                                                                    2


GUIDE FOR                                  2.     SURRENDER DETAILS
APPLICANTS                                 What type of mining tenement is to be surrendered?
                                                                                    Tick                    Number(s)
Question 2.1 to 2.3
Specify the mining tenement to be
surrendered and provide number.             2.1     Mining Claim

Question 2.4                                2.2     Mineral Development Licence
What mining district does the tenement
fall under?
                                            2.3     Mining Lease

                                            2.4     Mining District

Question 2.5, 2.6 and 2.8                  What is the relevant surrender type?
Indicate the intent of this surrender by
marking the relevant surrender type.                                                Tick

NOTE: Partial surrenders may only           2.5     Total Surrender
occur over mineral development
licences and mining leases.
                                            2.6     Partial Surrender                          2.7                        ha
Question 2.7
Indicate the number of hectares to be
partially surrendered.                              Total or Partial Surrender in
                                                    favour of new Mining Claim,
                                            2.8
Question 2.9                                        Mineral Development
Indicate the number of hectares to                  Licence, or Mining Lease
retain in the boundary of the mining
tenure.

Question 3                                  2.9     Area to be retained?                                          ha
You must describe the boundaries of
the area by accurately measured
distances and compass bearings. All
bearings are to be magnetic and            3.           DESCRIPTION OF RETAINED AREA
clockwise and the description should
indicate any abuttals, for example, a
bearing of 90˚00’ for a distance of 100    Commencing from              3.1
metres to or abutting the western
boundary of ML 70045.
                                           at a bearing of     3.2                      for a distance of   3.3             m,
You must also include a sketch map,
or other graphic representation
acceptable to the Mining Registrar         to     3.4                                                                   thence
setting out the boundaries of the land
being retained and the land required
as access. This map should also show
                                           at a bearing of     3.2                      for a distance of   3.3             m,
any mining claims, mineral
development licences, or mining            to     3.4                                                                   thence
leases (or applications for the grant of
one of these) within the boundaries of
the land being applied for.                at a bearing of     3.2                      for a distance of   3.3             m,
Please attach separate list if
insufficient space.                        to     3.4                                                                   thence

Question 3.1                               at a bearing of     3.2                      for a distance of   3.3             m,
Enter description of the external
boundary of the mining tenement area.
                                           to     3.4                                                                   thence
Question 3.2
Enter the compass bearing taken.
                                           at a bearing of     3.2                      for a distance of   3.3             m,
Question 3.3
Enter the distance, in metres, to the      to     3.4                                                                   thence
next post.

Question 3.4                               at a bearing of     3.2                      for a distance of   3.3             m,
Enter description, e.g. North West
Corner… etc
                                           back to the point of commencement.
                                                                                                 3

                                             4.      ACCESS
GUIDE FOR
APPLICANTS
                                              Will the registered access change?
Question 4
                                                                                         YES (Variation of Access
Will the registered access upon               4.1    Mining Lease                                                                 NO (go to Q 5)
approval of the partial surrender                                                        application must be lodged)
application?
                                                     Mineral
                                              4.2    Development                         YES (go to Q 4.3)                        NO (go to Q 5)
                                                     License


                                              What is the description of the access? (for MDL only)
Question 4.3
Insert the width of the access required       Width of Access required             4.3                        metres
in metres.
                                              What is the description of the start point?
Question 4.4                                  4.4
Insert the description of the start point,
e.g. At a point on the Mt Mulligan Road
2.15km NE of the Sandy Creek
crossing at co-ordinates…….

                                              What is the description of the end point?
Question 4.5
Insert the description of the end point,      4.5
e.g. The Southern boundary of the
mineral development license.



                                             Commencing from the start point, thence along the centreline at a bearing of
Question 4.6
Enter the compass bearings taken               4.6                     for a distance of           4.7                 m,   thence at a bearing of
along the centreline of the access.
                                               4.6                     for a distance of           4.7                 m,   thence at a bearing of
Question 4.7
Enter the distance, in metres, of the
access route on the compass bearing.           4.6                     for a distance of           4.7                 m,   thence at a bearing of

Question 4.8                                   4.6                     for a distance of           4.7                 m,   thence at a bearing of
Insert Lot Number of land on plan
registered in Titles Office.
                                               4.6                     for a distance of           4.7                 m,   thence at a bearing of
Question 4.9
Insert Registered Plan Number for lot.         4.6                     for a distance of           4.7                 m,   thence at a bearing of

Question 4.10                                  4.6                     for a distance of           4.7                 m,   thence at a bearing of
Insert Land Tenure Type, e.g.
freehold, special lease, pastoral
holding etc.                                   4.6                     for a distance of           4.7                 m,   to the end point.

Question 4.11
What is the land currently used for?          Describe the land parcels over which access mineral development license is
                                              required:
Question 4.12
Name of the owner of the land.
                                              Lot Number       4.8                                       Plan Number        4.9

Question 4.13
Address of the owner of the land.
                                              Land Tenure Type              4.10
You can obtain this information from a
Department of Environmental and
Resource Management (DERM)                    Current Usage          4.11
service centre.

                                              Owner’s Name           4.12
If insufficient space, please attach
separate list.
                                              Owner’s Address               4.13
                                                                                       4



GUIDE FOR                                Lot Number         4.8                             Plan Number     4.9

APPLICANTS
                                         Land Tenure Type                4.10
Question 5.1
Enter the name of place where the
application was signed, the day of       Current Usage            4.11
the month, the month and the year
when the form is signed.
                                         Owner’s Name             4.12
Question 5.2
Insert full name of the applicant(s).
                                         Owner’s Address                 4.13
Question 5.3
Signature of applicant(s).

Question 5.4
Insert full name of Witness.

Question 5.5
                                        5.      SIGNATURES
Signature of Witness.
                                        I/We:
Execution of Documents                           solemnly sincerely and truly declare that the information provided in this form
by an Agent                                      is true and correct.
                                                 understand that any false or misleading information may attract a maximum
If an agent or the holder of a power             penalty of 200 penalty units.
of attorney is signing a document,
required to be lodged by an Act, on
behalf of another, the agent or          5.1    Signed at                       this   day of                     , 20
holder of the power of attorney
must produce current, written
evidence of their authority to act at
                                         5.2                                                       5.3
the time of lodgement.

All of the holders of the tenure
MUST execute the appointment of
agent or the power of attorney for
the appointment or power of
attorney to be effective. A company      5.2                                                       5.3
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.
                                         5.2                                                       5.3




                                         5.2                                                       5.3




                                                    Full name and title of Holder(s)                          Signature

                                         5.4                                                       5.5

                                                            Full name of Witness                         Signature of Witness
                                                                                                    5

                                              6.         ACCOMPANIMENTS
GUIDE FOR
APPLICANTS                                     The following must accompany this form:
                                               6.1                                                                                                 Tick
Question 6.1 - 6.3
Tick the appropriate boxes to indicate               •    Prescribed fee
compliance.

                                                     •    The certificate of grant of mining claim or instrument of mineral
                                                          development licence or mining lease

                                                     •    A statement that you have satisfactorily complied with the
                                                          condition to carry out Improvement Restoration to the land (as
                                                          defined under section 6C of the Mineral Resources Act 1989)

                                                     •    If surrender is in favour of a new Mining Claim, Mineral
                                                          Development Licence or Mining Lease then the application for
                                                          the new Mining Claim, Mineral Development Licence or Mining
                                                          Lease must accompany this form

                                                     •    Provide a sketch map showing the boundaries of the area of the
                                                          mineral development licence to be retained or that part of the
                                                          mining lease to remain in force together with the written
                                                          description supplied in description of area retained.

                                              6.2 Additional accompaniments for Mining Leases and Mining Claims

                                                     •    Duly completed royalty return together with royalty payable (if
                                                          any) – Mining Lease and Mining Claim only (Total Surrender Only)

                                                     •    Evidence of payment to the person entitled to royalty – Mining
                                                          Lease and Mining Claim only (Total Surrender Only)

                                                     •    Access Requirements:
                                                               o    If land used as access in relation to the land the subject
                                                                    of the mining lease is altered or varied by partial
                                                                    surrender then an Application for Variation of Access
                                                                    (MRA-26) is required to be completed in the approved
                                                                    form and lodged with this application for partial
                                                                    surrender.

                                              6.3 Additional accompaniments for Mineral Development Licenses

                                                     •    Access Requirements:
                                                               o    If land other than specified in the mineral development
                                                                    licence is required as access from a point outside the
                                                                    boundary of the land the subject of the mineral
                                                                    development licence to be retained to any part on the
                                                                    surface of that land, then such land is to be set out on
                                                                    the sketch map as mentioned above, described
                                                                    Question 4.

                                              6.4 Department of Environment and Resource Management requirements:

                                                     •    Completed Application for Surrender or Partial
                                                          Surrender/amendment of the Environmental Authority


Disclaimer
The Department of Employment, Economic Development and Innovation is collecting information provided on this form for the purposes of assessing the
suitability of your surrender and maintain the public searchable register under the Mineral Resources Act 1989 (‘the Act’). This information is authorised
by sections 107,210,309 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.

				
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