CER-RET-028

FORM
CER-RET-028
V1.003/08/2016

2016 Application for exemption certificate–
change of liable entity

under the Renewable Energy (Electricity) Act 2000

Purpose of this form

Under the Renewable Energy (Electricity) Act 2000 (the Act) electricity consumed through emissions-intensive trade-exposed (EITE) activities may be eligible for exemption from Large-scale Renewable Energy Target and Small-scale Renewable Energy Scheme liability.

Prescribed persons can elect to trade their exemption certificate to a liable entity—providing the liable entity with exemption from liability for a portion of megawatt-hours of electricity in the given compliance year.

If the liable entity changes during the 2016 year, the prescribed person may use this form to apply for another exemption certificate in relation to the new liable entity.

Eligibility

This form may be used by a prescribed person to apply to the Clean Energy Regulator for another exemption certificateunder regulation 22L of the Renewable Energy (Electricity) Regulations 2001(the Regulations) ifduring the 2016 year the liable entity namedon the existing exemption certificate ceases to supply electricity to the site detailed on the certificate, and a new liable entity begins supplying electricity to the site.

Submitting this form

The ‘2016 Application for exemption certificate- change of liable entity’ form must be received by the Clean Energy Regulator on or before3 January 2017(under regulation 22X(2)).

By post

Post your completed application with any accompanying documentation to:

Clean Energy Regulator
Industry Assistance Schemes
GPO Box 621
Canberra ACT 2601

A copy of the signed form should be kept for your records.

By fax

You can submit your completed application via fax to 02 6159 3886. Please ensure that the original hard copy is also sent in the post.

A copy of the signed form should be kept for your records.

Instructions for completing this form

Please read each part of the application carefully, fully answer all the questions, sign where indicated, and attach the required documentation.

You must complete and submit:

  • Part A: Prescribed person - change of liable entity
  • Part B: Applicant details
  • Part C: Liable entity
  • Part D: Calculation for splitting exemption between two or more liable entities
  • Part E: Declaration
  • Part F: Statutory declaration

If there is not sufficient space to complete your answer, provide the answer as an attachment.

Please reference and label attachments in a logical manner. Lengthy or large attachments may be provided in electronic format (e.g. by email).

You can choose to complete this form by:

  • printing the form and filling it in by hand, or
  • saving the form and filling in an electronic copy.

Note that if you choose the second option, there may be times when you will need to print certain sections in order to sign them or in order to complete multiple entries for a single set of questions.

Pen colours / Please use a black or blue pen to write on the form.
Check boxes / Mark boxes like this  with a ✔ or ✘. When an instruction asks you to ‘tick’ the box, you can still use either ✔ or ✘.
Go to / Where you see an instruction like this - Go to question 5 - mark the relevant box with a ✔ or ✘and then skip to the question number shown. You do not need to answer the question(s) in between.
Where an instruction has a black double arrow (), go to the next indicated part/section. Where an instruction has a black single arrow (), go to the next question. Where an instruction has a black single arrow pointing down (), fill in the field(s) directly below.
Mandatory questions / If all fields in a question are mandatory and must be completed, (required) is added to the end of the question label text. If a field in a question is mandatory only IF a condition is met, (required if any) is added to the end of the question label text.
 / This symbol indicates an instruction on what to do next.
 / This symbol indicates additional useful guidance to filling in the adjacent field or section.
 / This symbol advises that more than one entry may be required for the section and therefore you may need to photocopy or print the section or fill in a duplicate section.
 / This symbol advises that additional documentation to support a claim may need to be attached to the application.

Help filling in this form

If you require assistance or have any questions regarding this application process, please contact the Clean Energy Regulator general enquiries line on 1300 553 542 or email
.

Part A:Prescribed person- change of liable entity

  1. Please explain briefly how you are a prescribed person under regulation 22L (required)

Explanation
  1. Were you issued an exemption certificate in relation to an EITE activity and site in 2016? (required)

Yes
No / You do not meet the criteria to apply for an exemption certificateas a prescribed person under regulation 22L
  1. What is the identification number of the exemption certificate?(required)

This is the number on the certificate issued by the Clean Energy Regulator (e.g. 2016-XXXX-0075-A)

Exemption Certificate ID
  1. During 2016, did the liable entity stated on the exemption certificate cease to be the liable entity in relation to the electricity consumed at the site? (required)

Yes
No / You do not meet the criteria to apply for anexemption certificate as a prescribed person under regulation 22L
  1. Who is the new liable entity in relation to the electricity consumed at the site? (required)

New liable entity

Part B:Applicant details

Applicant details

Please provide details relating to the applicant.

  1. Applicant name(required)

This is the name that appears on the Australian Business Register (see ABR website to check: ).

Name
  1. Trading name (required if any)

Provide the trading name, if any.

Name
  1. Postal address(required)

The Clean Energy Regulator will use this address for all correspondence related to the assessment of this application.

Address line 1
Address line 2
Address line 3
Suburb/city
State/territory
Postcode
Country
  1. Identifying details (required)

You must provide one of the following for the applicant in order of precedence: ABN, ACN, ARBN or trading name and street address.

ABN

If the applicant does not have an ABN, please provide the applicant’s ACN.

ACN

If the applicant does not have an ABN or an ACN, please provide the applicant’s ARBN.

ARBN

If the applicant does not have an ABN, ACN or an ARBN please provide the applicant's trading name and street address.

Are the trading name and the street address the same as those provided at questions 7and 8?

Yes / Go to question 10
No / Provide details below
Trading name
Address line 1
Address line 2
Suburb/city
State/territory
Postcode
Country

Primary contact person

Nominate a primary contact person with whom the Clean Energy Regulator will deal on matters relating to the application.

  1. Primary contact person’s details (required)

Provide the person’s full name.

Title
(e.g.Ms, Mr, Mrs, Dr)
Given name(s)
Last name

Provide the person’s position.

Position

Provide the person’s contact details.

Phone number
Email

Secondary contact person

The Clean Energy Regulator may contact this person if the primary contact is not contactable.

  1. Secondary contact person’s details (required)

Provide the person’s full name.

Title
(e.g. Ms, Mr, Mrs, Dr)
Given name(s)
Last name

Provide the person’s position.

Position

Provide the person’s contact details.

Phone number
Email

Executive officer

The Clean Energy Regulator may contact this person if required.

  1. Executive officer details (required)

Provide the executive officer’s position.

Position

Provide the executive officer’s full name.

Title
(e.g. Ms, Mr, Mrs, Dr)
Given name(s)
Last name

Provide the executive officer’s contact details.

Phone number
Email

Emissions-Intensive trade-exposed activity

In this section you will identify the EITE activity carried out at the site relating to this application

  1. EITE activity details (required)

Identify the EITE activity to which this application relates.

A list of all eligible EITE activities is included in Schedule 6 to the Regulations and summarised in Appendix E to this form.

Name of EITE activity
  1. How will the EITE activitybe carried on at the site (required)

If the information has not already been provided to the Clean Energy Regulator, describe how the EITE activity will be carried on in the context of total production at the site in 2016, and state how requirements relating to the relevant activity definition under Schedule 6 to the Regulations are met. Check one of the boxes below.

If insufficient space please provide additional information as an attachment.

All relevant informationwas provided to the Clean Energy Regulator with a previous exemption certificate application and no changes have occurred to how the EITE activity is carried out on the site that is reflected in that information.
How the EITE activity is carried on at the site (if not already provided)

Quantity of relevant product

In this section you will provide details of the quantity of relevant product for 2014-15 in relation to the EITE activity carried on at the site. Provide additional information as attachments if required.

  1. If the information has not already been provided to the Clean Energy Regulator, provide details of each relevant product in relation to the site.

Attach a copy of Appendix D for each relevant product, unless this information has already been submitted to the Clean Energy Regulator in a previousexemption certificate application.

All relevant informationwas provided to the Clean Energy Regulator with a previous exemption certificate application and no changes have occurred to the relevant product reflected in that information
Attached

Part C:Liable entity

The Clean Energy Regulator may seek your permission during the assessment process to contact the liable entity for clarification about the information provided in this application.

Liable entity details

Provide details of the new liable entity in relation to the electricity consumed at the site, whom the exemption certificate will relate to

  1. New liable entity details (required)

Provide the name of the liable entity.

This is the name that appears on the Australian Business Register (see ABR website to check: ).

Company name

Provide the trading name if any.

Trading name

Which name is used in the REC Registry?

Company name
Trading name

Provide the ABN for the liable entity.

ABN
  1. Specify the circumstances in which the old liable entity ceased to be the liable entity (required)

Details of the change of liable entity
  1. Provide evidence of the date on which the old liable entity ceased to be the liable entity and the date on which the new liable entity became the liable entity (required)

Attach evidence of dates, such as the schedule to the new electricity supply contract.

Attached
  1. Provide evidence that both the old and new liable entities have been informed of the application for anexemption certificate(required)

Attach evidence that both liable entities have been informed of the application.

Attached

Part D:Calculation for splitting exemptionbetween two or more liable entities

Calculate the expected exemption for the new liable entity for 2016.

  1. What is the amount of the exemption set out in the exemption certificate issued in relation to the old liable entity? (required)

Amount ofexemption / MWh (OL)
  1. What is the number of days in 2016 for which the newliable entity will be the liable entity?(required)

Days / MWh (D)
  1. What is the number of days in 2016 for which the old liable entity was the liable entity?(required)

Days / MWh (OLD)
  1. Is this application in relation to a third liable entity for 2016 in relation to the EITE activity and site? (required)

Yes / Go to question 25
No / Go to question 24
  1. Estimate the exemption you expect to be set out in the exemption certificate for the new (second) liable entity for 2016 in relation to the EITE activity and site, based on the method of regulation 22ZF(required)

Please calculate the exemption using the formula:

Note 2016 has 366 days.

Estimated amount of exemption / MWh

You have completed this section. Go directly to Part E. 

  1. Estimate the exemption you expect to be set out in the exemption certificate for the new (third) liable entity for 2016 in relation to the EITE activity and site, based on the method in regulation 22ZF(required)

Please calculate the exemption using the formula:

Estimated amount of exemption / MWh

Part E:Declaration

This section must be signed by the applicant, if an individual, or by a representative of the applicant on their behalf.

By signing below, the signatory

a)declares that the information supplied in this form is true and correct and that he/she is authorised to make this application on behalf of the applicant named in the form;

b)acknowledges that giving false or misleading information is a serious offence and carries penalties under the CriminalCodeAct1995;

c)acknowledges thatthe Regulator may amend an exemption certificate in accordance with the provisions of section 46C of the Renewable Energy (Electricity) Act 2000 (the Act);

d)acknowledges thatthe Regulator can seek to verify information provided under the Act or check compliance with the Act by consent or monitoring warrant. Authorised officers of the Clean Energy Regulator can request or require that information be provided as part of this process;

e)acknowledges thatfailure to provide information to an authorised officer when requested under a monitoring warrant constitutes an offence with a maximum penalty of imprisonment for 6 months under section 113 of the Act;

f)acknowledges thatknowingly providing false or misleading evidence is an offence with a maximum penalty of imprisonment for 12 months under section 125E of the Act;

g)acknowledges thatthe Regulator must publish information about exemptions on its website, as specified under section 38C of the Act;

h)acknowledges thatthe Act (section 160) and the Renewable Energy (Electricity) Regulations 2001 (regulation 22ZT) impose an obligation with respect of the retention of records relating to this form; and

i)acknowledges thatprotected information provided in the application will be treated in accordance with the secrecy provisions of the Act and the Clean Energy Regulator Act 2011 (noting that these may allow information to be divulged to specified persons or bodies under specified circumstances).

Full name of signatory
Title/position
Organisation
(if applicable)
Signature
Day (dd) / Month (mm) / Year (yyyy)
Signature date

Part F:Statutory declaration

  1. Verification of application by statutory declaration (required)

You must complete the statutory declaration provided on the next page to verify that the information in this application is accurate and complete.

The statutory declaration must be made by one of the following persons:

  • A director of the applicant
  • The applicant’s chief executive officer
  • The applicant’s chief financial officer
  • The applicant’s company secretary

It is important to ensure that:

  • The full name, address and occupation of the person making the declaration are included in item 1
  • The full name, qualification and address of the person before whom the declaration is made are included at item 8.

Attach the original signed statutory declaration made in accordance with the Statutory Declarations Act 1959. Tick the box to confirm the declaration has been attached.

Documentary evidence type / Attached
Statutory declaration
Commonwealth of Australia
STATUTORY DECLARATION
Statutory Declarations Act 1959
1Insert the name, address and occupation of person making the declaration / 1 I,
make the following declaration under the Statutory Declarations Act1959:
2Set out matter declared to in numbered paragraphs / 2 I state that, based on all reasonable steps having been taken to verify the information in this application, this application is accurate and complete as far as I know.
I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959,and I believe that the statements in this declaration are true in every particular.
3Signature of person making the declaration / 3
4Place
5Day
6Month and year / Declared at 4 on 5 of 6
Before me,
7Signature of person before whom the declaration is made (see over) / 7
8Full name, qualification and address of person before whom the declaration is made
(in printed letters) / 8

Note 1:A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of four years. See section 11 of the Statutory Declarations Act 1959.

Note 2:Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959. See section 5A of the Statutory Declarations Act 1959.

Statutory declaration criteria

A statutory declaration under the Statutory Declarations Act 1959 may be made before

V1.0 03/08/20162016 Application for exemption certificate- change of liable entity1 of 2

CER-RET-028

a)(1) a person who is currently licensed or registered under a law to practise in one of the following occupations:

  • Chiropractor
  • Dentist
  • Legal practitioner
  • Medical practitioner
  • Nurse
  • Optometrist
  • Patent attorney
  • Pharmacist
  • Physiotherapist
  • Psychologist
  • Trade marks attorney
  • Veterinary surgeon

b)(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described), or

c)(3) a person who is in the following list:

  • Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public
  • Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)
  • Bailiff
  • Bank officer with 5 or more continuous years of service
  • Building society officer with 5 or more years of continuous service
  • Chief executive officer of a Commonwealth court
  • Clerk of a court
  • Commissioner for Affidavits
  • Commissioner for Declarations
  • Credit union officer with 5 or more years of continuous service
  • Employee of the Australian Trade Commission who is:
  1. in a country or place outside Australia; and
  1. authorised under paragraph 3 (d) of the Consular Fees Act 195, and
  2. exercising his or her function in that place
  • Employee of the Commonwealth who is:
  1. in a country or place outside Australia; and
  1. authorised under paragraph 3 (c) of the Consular Fees Act 1955, and
  2. exercising his or her function in that place
  • Fellow of the National Tax Accountants’ Association
  • Finance company officer with 5 or more years of continuous service
  • Holder of a statutory office not specified in another item in this list
  • Judge of a court
  • Justice of the Peace
  • Magistrate
  • Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961
  • Master of a court
  • Member of Chartered Secretaries Australia
  • Member of Engineers Australia, other than at the grade of student
  • Member of the Association of Taxation and Management Accountants
  • Member of the Australasian Institute of Mining and Metallurgy
  • Member of the Australian Defence Force who is:
  1. an officer; or
  1. a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or
  2. a warrant officer within the meaning of that Act
  • Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants
  • Member of:
  1. the Parliament of the Commonwealth; or
  1. the Parliament of a State; or
  2. a Territory legislature; or
  3. a local government authority of a State or Territory
  • Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961
  • Notary public
  • Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public
  • Permanent employee of:
  1. the Commonwealth or a Commonwealth authority; or
  1. (b) a State or Territory or a State or Territory authority; or
  2. a local government authority;

with 5 or more years of continuous service who is not specified in another item in this list