Form B27, B29

Mines & Minerals Act 2009

Application for a Permit

1. Licence type being applied for (enter ‘X’ in the appropriate box)
Radioactive Minerals Permit
Dredging Permit
2. Applicant details
Name / Position
3. Proposed Supervisor (incl. qualification to handle radioactive material if applicable)
Name / Qualification(s)
4. Related Licence Details
Is application in respect of an application for or an existing licence? Yes No
If Yes, give details (Note: If the applicant is not the exploration licence holder, the exploration licence holder must give signed consent below)
Licence Number / Licence Holder
Further details
5. Attachments
All applicants must consult Table A7 of the First Schedule for a list of the required attachments to this application. No application will be processed without the required attachments, although an application fee may still be payable upon each submission.
Documents attached
5.1
5.2
5.3
5.4
5.5
5.6
[INSERT ROWS AS NEEDED]
Declaration by licence holder (where not the applicant)
Licence Number / Licence Holder
I hereby declare that I have no objection to the grant of a small-scale mining licence, as detailed in the above application, within the area of my exploration licence
Licence Holder Signature / Date
Witness name / Witness address
Applicant signature / Date

Applicants Note:Please complete all boxes (or enter `none, N/A etc) and provide all attachments as necessary. Attachments should be numbered to correspond to this form. This application will be deemed incomplete and consequently invalid if any required information is not provided. Sixteen copies of this application and of all attachments must be supplied.The complete application should be submitted to the Mining Cadastre Office wherein application will be reviewed, process and an ‘Order to Pay the Application Fee’ generated as prescribed in Table A1 of the First Schedule. Once payment is made and the receipt (or a copy) is received by the MCO this application will be deemed compliant. This fee is non-refundable should the application be invalid for any reason or if, after consideration by the Minerals Advisory Board and the Minister, it is refused.

For Official Use by Mining Cadastre Office
Application details
Received by / Signature / Date
Processing details
Details entered and attachments checked / Order to Pay Application Fee Produced / APL Number

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