Further Information

Important Note: This notification must be provided to the agency(see overleaf) for the State or Territory in which the relic is located, within 30 days of coming into possession, custody and control of the relic.

Contact details of the person giving notice
First name: / Surname:
Town/City: / State: New South WalesVictoriaWestern AustraliaQueenslandSouth AustraliaNorthern TerritoryNorfolk IslandAustralian Capital Territory
Street number: / Street name:
Mobile: / Postcode: / Post office box:
Telephone (Business hours): () / Facsimile: ()
Email:
Additional details if the relicsare held by a business, association or government entity
Name: / ABN:
Details if the possession, custody or control is the result of a transfer of possession
Permit number: / Date of transfer:
Description of relic (Include photographs or digital images of the relic where possible)
Registered number
(If registered) / Type of object
(coin, anchor, bottle etc) / Features
(markings, writing, design etc) / Dimensions
(length, width, height, weight)
L cm / W cm
H cm / W g
L cm / W cm
H cm / W g
L cm / W cm
H cm / W g
L cm / W cm
H cm / W g
Please answer the following questions (attach additional information if space insufficient)
Where was the relic found or acquired?
Which historic shipwreck is the relic associated with (Fill in details below if known)?
Name of shipwreck:
National Shipwrecks Database ID number:
In which State or Territory is the historic shipwreck relic currently located? New South WalesVictoriaWestern AustraliaQueenslandSouth AustraliaNorthern TerritoryNorfolk IslandAustralian Capital Territory
Where is the relic stored?
How is the relic stored?
What is the condition of the relic?

I declare that the information I have given on this form is correct to the best of my knowledge.

Name (block letters):
Date: / Signature:

Further Information

Further Information

Information on the protection of Australian historic shipwrecks and relics under the Historic Shipwrecks Act 1976 can be obtained from:

Contact detailsfor State and Territory agencies:

Further Information

Heritage Branch

New South Wales Department of Planning

Locked Bag 5020

PARRAMATTA NSW 2124

Tel: (02) 9873 8500

Fax:(02) 9873 8599

Email:

Heritage Branch

Northern Territory Department of Natural Resources, Environment the Artsand Sport

PO Box 496

PALMERSTON NT 0831

Tel:(08) 8999 5532

Fax:(08) 8999 8949

Email:

Heritage Branch

Queensland Department of Environment and Resource Management

GPO Box 2454

BRISBANE QLD 4001

Tel:(07) 1300 130372

Fax:(07) 3330 5875

Email:

WesternAustralianMuseum

Maritime Archaeology Department

45-47 Cliff Street

FREMANTLE WA 6160

Tel:(08) 9212 3700

Fax:(08) 9431 8489

Email:

Heritage Branch

South Australian Department for Environment and Natural Resources

GPO Box 1047

ADELAIDE SA 5001

Tel:(08) 8124 4960

Fax:(08)8124 4980

Email:

Heritage Tasmania

Department of Primary Industries, Parks, Water and Environment

GPO Box 1751

HOBART TAS 7001

Tel:(03) 6233 2387

Fax:(03) 6224 0884

Email:

Heritage Victoria

Department of Planning and Community Development

GPO Box 2392

MELBOURNE VIC 3001

Tel:(03) 8644 8800

Fax:(03) 8644 8951

Email:

Norfolk IslandMuseum

Kingston

NORFOLK ISLAND NSW 2899

Tel:(0011) 672 323 788

Fax:(0011) 672 323 788

Email: