Application for a Commercial Producer’s Licence

Application for a Commercial Producer’s Licence

To sell protected (native) flora taken from, or grown and cultivated on, private property

Completed forms should be returned to:
Department of Parks and Wildlife
Locked Bag 30 Bentley Delivery Centre WA 6983
Or faxed to (08) 9334 0242 or emailed. / Further information on the licensing requirements is available from DPaW Wildlife Licensing Section
Phone: (08) 9219 9836
Email:

COMMERCIAL PRODUCER’S (PN) LICENCES ARE ISSUED FOR A MAXIMUM 1-YEAR PERIOD, WITH A $25 FEE.

PLEASE ALLOW APPROXIMATELY TEN (10) WORKING DAYS TO PROCESS COMPLETE AND CORRECT APPLICATIONS.

PLEASE NOTE THAT RENEWAL OF A LICENCE IS DEPENDENT ON SATISFACTORY COMPLETION AND SUBMISSION OF FLORA RETURNS.

Applicant:

Surname
Dr/Mr/Mrs/Miss/Ms / Other names
Address (residential)
Postcode
Address (postal)
Postcode
Day time Telephone / Business Name (if applicable)
Date of birth / / / / Previous Licence No.: Expiry Date:
PN0…………….. / /

Land to which application relates (Note: A letter of permission from ALL of the land owners is required to pick on lands other than your own - see Proforma letter page):

Name of Local Government Authority (e.g. Shire, City) / Street Address
(eg. Avon Loc 123, Flora Road, Floraville) / Property Name (if applicable) / Owner or Occupier


Flora to which application relates

o Seed/Stems (circle your selection) of all flora, except Declared Rare Flora and Priority flora taken from Natural (P)/Cultivated (A) (circle your selection) stands.

OR

Scientific Name
(e.g. Banksia prionotes) / Common Name (if any) / Parts to be taken (e.g. Flowering Stems, Fruits/Nuts, Seeds, Leaves, Cuttings) / Natural (P)
or
Cultivated (A)

OR

o List attached. (The list must contain the same fields as the above example)

Note 1: for the sale of Sandalwood (Santalum spicatum) wood taken from private land, a valid Sandalwood Act Licence is required

Note 2: for the sale of major forest products (log timber), please see “Application for a Commercial Producer’s Licence - Timber”

Note 3: for the sale of whole plants, please see “Application for a Commercial Producer’s Licence - whole plants”

/ /
Signature of Applicant / Date

Payment (Please select one of the following payment methods):

o Cheque enclosed

o Money order enclosed

o Payment made at DPaW office (refer to ‘Office Use Only’ section below)

o Credit Card (complete ‘Credit Card Payment’ section below)

No responsibility will be taken for cash payments sent via mail.

Credit Card Payment (VISA & MASTERCARD ONLY) **Please print clearly**
o o o o o o o o o o o o o o o o
Name of Cardholder: ______Expiry Date: ____/____
Signature of Cardholder: ______

Page 2 of 3

Application for a Commercial Producer’s Licence

Proforma letter (for a private property owner/occupier) to authorise other persons to harvest and sell protected flora from land stated below, and apply for a licence issued under the Wildlife Conservation Act 1950 to do so.

Land owner/occupier details:

Name of the land owner/occupier (delete whichever does not apply): ……………………………………..……..

Postal address of the land owner/occupier: …………………………………………...

……………………………………………

……………………………………………

Contact telephone number for the land owner/occupier: ………………………………………………..…

Land permission details:

Please be advised that as the owner/occupier (delete whichever does not apply) of the property:

Property name: ………………………………………….………..

Lot/Location No(s) or Street Address: …………………………………………….……..

Local Government Authority: ………………………………….……….……….

I give permission for …………………………………………….. (print name of applicant) of ……………………………………………………….…………….. (print address) to harvest and sell the following species of protected flora from my property as listed above.

Flora species to which this authorisation applies: Either tick the ‘All species’ box, list the species in the space provided, or tick the ‘List attached’ box and attach and sign a list:

o All species OR o List attached OR ……………………….……………

…………………………….………. …………………………….……….

…………………………….………. …………………………….……….

Period for which this authorisation applies: Either tick the ’12 months from date of issue’ box, or state a time period (Note: Permissions can only be granted for a maximum of 12 months):

o 12 months from date of issue OR …..…/……/20….. to ………/……/20.….

Special conditions that apply to this authorisation (e.g. area, methods, use of facilities):

………………………………………………………………….…………………………………………………….…………………………….………...……………………………………………………………………….

Signed ...... …………………
Name(Print): …………………………….…………
Date ...... /...... /20...... / This proforma may be photocopied to allow for attaching multiple permissions for multiple private properties.

Page 3 of 3