Statements of Corporate Compliance, Environmental Performance History and Financial Capability

NSW Department of Planning and Environment, Division of Resources and Geoscience

Statements of corporate compliance, environmental performance history and financial capability

Guideline | Template

Statements of corporate compliance, environmental performance history and financial capability

For grant, transfer or renewal applications
(excluding small scale titles)

June 2018 | v1.4

More information

For help with lodging this application,or for more information

about authorisations in New South Wales, contact:

Division of Resources and Geoscience

Titles Customer Assistance Line

Phone +61 2 4063 6600

This publication is copyright. You may download, display, print and reproduce this material providing that the wording is reproduced exactly, the source is acknowledged, and the copyright, update address and disclaimer notice are retained.

The information contained in this publication is based on knowledge and understanding at the time of writing. However, because of advances in knowledge, users are reminded of the need to ensure that information upon which they rely is up to date and to check currency of the information with the appropriate officer of the NSW Department of Planning and Environment or the user’s independent advisor.

Privacy statement

This information is collected by the Department of Planning and Environment (the department) for the purposes of assessing an application for an authorisation or associated with an authority as required by the Mining Act 1992,Mining Regulation 2016, Petroleum (Onshore) Act 1991andPetroleum (Onshore) Regulation 2016.

This information may also be used by the department to confirm applicant details in the event that subsequent applications are made, and may also be used to establish and maintain databases to assist the department with its work generally.

Except for purposes required by law, the information will not be accessed by any third parties in a way that would identify the person without the consent of that person.

You may apply to the department to access and correct any information the department holds if that information is inaccurate, incomplete, not relevant or out of date.

NSW Department of Planning and Environment, Division of Resources and Geoscience

Statements of corporate compliance, environmental performance history and financial capability

When to usethis form

The NSW Department of Planning and Environment, Division of Resources & Geoscience (the Division) assesses applications for activities to explore and extract the resources of the state of NSW for the benefit of the people of NSW. The NSW Resources Regulator (also within the department) is responsible forcompliance and enforcement across exploration and mining activities in the state, including conducting assessments of applications.

To ensure that exploration licences, assessment leases and mining (or production) leases are held by individuals or companies that meet the objects of the Mining Act 1992 or the Petroleum (Onshore) Act 1991 the Divisionand the Resources Regulator require certain information in relation to individuals and companies making an application.

When assessing a grant, transfer or renewal application, the department requires the following from each applicant, or in the case of a transfer, each transferee:

a statement regarding corporate history (if applicable)
information about compliance record and environmental performance, and
a financial capability statement.

Document control

RM8 Reference: PUB16/544

Amendment schedule
Date / Version # / Amendment
01 December 2016 / 1.0 / Issued to replace Statement of financial capability PUB16/287 v5.1 September 2016 and Statement of corporate, compliance and environmental performance history v4, 11 November 2015
13December 2016 / 1.1 / Table 2.2, Table 2.3, Sections 3 and 4, Definitions
19 December 2016 / 1.2 / Field formatting issues fixed
28 March 2017 / 1.3 / Minor formatting fixes
22 June 2018 / 1.4 / Departmental changes, Sections 3 and 4, Definitions

1Applicant or transferee details

The department will obtain third party information on the applicant or transferee that is reasonably necessary for performing its functions.

Applicant or Transferee /
A.C.N: (if applicable) /

2Company declaration

Note: Question 2 only applies to an applicant or transferee that is a Company.

Table 2.1: Current Officers of the applicant or transferee

Officer’s Name / Role / Date appointed

Use the text box below to provide details of an ASIC search or note whether an extract is attached.

Table 2.2:List the name of the Ultimate Holding Company of the applicant(if applicable)

Details of Ultimate Holding Company / Sharesheld (%)

Table 2.3:Related Body Corporate

List the names of theRelated Body Corporate of the applicant (if applicable)

Related Body Corporate Name / A.C.N.

3Other declarations

The following declarations apply where the applicant or transferee is either an Individual or a Company. In the case of applicants or transferees who are a Company, the following declarations also apply to allcurrent company officers.

Has the applicant or transferee:

Been (either currently or within the last threeyears) associated with an approval authorisation for the exploration or production of coal, mineral or petroleum resources in any jurisdiction other than NSW?(Please note that this information is not required for an application of renewal).

Yes, I have included details of other jurisdictions below or attached details of the relevant jurisdictions other than NSW (if applicable).

No.

Not applicable to an application for renewal.

3.1Compliance and environmental performance history

3.1.1Inthelasttenyears,hadanapprovalauthorisingexplorationorproductionofcoal,mineralorpetroleumresources, in any jurisdiction,refused, suspended, cancelled or revoked?

YesNo

3.1.2In the last ten years, been subject to a prosecution under a provision of any Work Health andSafety legislation in any jurisdiction or have the charges currently pending?

YesNo

3.1.3In the last ten years, been convicted of an offence under a provision of the Mining Act 1992, Protection of the Environment Operations Act 1997or other relevant legislation in any jurisdiction, as set out in Schedule 5 of Mining Regulation 2016or have charges currently pending?

YesNo

3.1.4In the last ten years, had a licence or other authority suspended or revoked under the Protection of the Environment Operations Act 1997 (NSW)?

YesNo

3.1.5In the last ten years, paid a penalty under a penalty notice for an offence under the Mining Act 1992, Protection of the Environment Operations Act 1997, Work Health and Safety legislation or other relevant legislation (NSW jurisdiction only) as set out in Schedule 5 of Mining Regulation 2016?

YesNo

3.1.6In the last ten years, been subject to an agreed enforceable undertaking, pursuant to theMining Act 1992, thePetroleum (Onshore) Act 1991, Protection of the Environment Operations Act 1997,Work Health and Safety Act 2011 or other relevant legislation as set out in Schedule 5 of Mining Regulation 2016?

YesNo

3.2Financial historyinformation

3.2.1Been convicted under the Proceeds of Crime Act 2002 (Commonwealth) or under the Crimes Legislation Amendment (Serious and Organised Crime) Act 2010 (Commonwealth), or for offences of money laundering, terrorism financing or corruption under any Commonwealth or State Act, or have charges currently pending?

YesNo

3.2.2Been convicted in New South Wales or elsewhere for a serious offence involving fraud or dishonesty that was recorded in the last 10 years, or have charges currently pending?

YesNo

3.2.3Been convicted in New South Wales or elsewhere for a serious offence relating to the management of a company, recorded within the last five years, or have charges currently pending?

YesNo

3.2.4Beena director or officer of a company that has been wound up,is the subject of a winding up order or for which a receiver, receiver and manager, controller or administrator has been appointed under the Corporations Act 2001 (Commonwealth), during the last three years?

YesNo

3.2.5Been an undischarged bankrupt or applied to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounded with his or her creditors or made an assignment of his or her remuneration for their benefit, during the last three years?

YesNo

3.2.6Been disqualified from holding office in a company under any law of New South Wales or any other State or Territory or the Commonwealth, during the last 3 years?

YesNo

I certifythat the information provided is true and correct to the best of my knowledge and belief. I understand under the Crimes Act 1900 NSW Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence; and under the Mining Act 1992 s378c and under the Petroleum (Onshore) Act1991 s125D, any person who provides information that the person knows to be false or misleading is guilty of an offence, for which they may be subject to prosecution.

Name: / Signature: / /
Position: / Date:

Ifyouhaveanswered‘Yes’toanyofthequestions in Section 3.1 or 3.2,pleaseensureyouattachaseparatestatementsettingoutthespecificcircumstancesofthehistoryandstatingreasons why youthinkthosecircumstancesshouldnotpreventyoufrom holdingatitle.

NOTE:Thepersonprovidingtheseparatestatementmust ensure that their statement includesacertificationastotheinformationbeingtrueandcorrectinthefollowingterms:

Icertifythattheinformationprovidedistrueandcorrecttothebestofmyknowledgeandbelief.IunderstandundertheCrimesAct1900NSWPart5A,thatknowinglyorrecklesslygivingfalseormisleadinginformationisaseriousoffence;andundertheMiningAct1992s378candunderthePetroleum(Onshore)Act1991s135,anypersonwhoprovidesinformationthatthepersonknowstobefalseormisleadingisguiltyofanoffence,forwhichtheymaybesubjecttoprosecution.

4Statement of financial capability

This section outlines the information required to support a grant, renewal or transfer in accordance with the Mining Act 1992 or the Petroleum (Onshore) Act 1991 forthe assessment of the applicant’s or transferee’s (in the case of a transfer) financial capability to carry out the proposed work programs.

The statement of financial capability is to be completed by the applicant or transferee (not an agent).

In the case of a natural person—the applicant(or for a transfer, the transferee) completes the statement.
In the case of a Company—a Company Secretary or Director of the applicant company (or for a transfer, the transferee) completes this statement.

STATEMENT

Enter applicant or transferee
Enter address
Enter city state postcode

I confirm that as at the date of the application there are reasonable grounds to believe that that the planned expenditure can be financed for the term of the work program or operations.

In establishing reasonable grounds that the planned expenditure can be metfor the term of the work program I have had regard for the following:

the work program or operations
all other current and proposed commitments
current assets and liabilities

I, as at the date of the application, am not aware of any other financial commitments which may negatively impact upon the commitment to complete the term of the work program.I certify that the information provided in this application is true and correct. I understand that under the Crimes Act 1900 Part 5A, that knowingly or recklessly giving false or misleading information is a serious offence; and under the Mining Act 1992 s378c and under the Petroleum (Onshore) Act 1991s125D, any person who provides information that the person knows to be false or misleading is guilty of an offence, for which they may be subject to prosecution.

I also acknowledge that NSW Department of Planning and Environment will take into consideration assessments and financial information provided by third parties.I understand that where adverse material is identified, I may be required to produce detailed financial information at my (or the applicant/company’s) expense.

Signed

Insert name
Insert position
Insert date

Definitions

Term / Meaning
Current or other proposed commitments
Refer to Accounting Standard AASB 101 Presentation or Financial Statements published by the Australian Accounting Standards Board / Current Commitment
According to Chartered Accountants Australia for the purposes of the accounting standards, entities may recognise liabilities (a present obligation of the entity arising from past events, the settlement of which is expected to result in an outflow of resources embodying economic benefits to the entity) or provisions (a liability where the timing or amount of the expected outflow is uncertain) in their financial statements.
Proposed Commitment
They must also disclose (but do not include in the statement of financial position/balance sheet) contingent liabilities which are either possible obligations whose existence will be confirmed by future events or present obligations which cannot be measured reliably or for which it is not probable that the obligation will be settled).
Current assets and current liabilities
Refer to Accounting Standard AASB 101 Presentation or Financial Statements published by the Australian Accounting Standards Board / Current Assets
An entity shall classify an asset as current when:
(a) it expects to realise the asset, or intends to sell or consume it, in its normal operating cycle;
(b) it holds the asset primarily for the purpose of trading;
(c) it expects to realise the asset within twelve months after the reporting period; or
(d) the asset is cash or a cash equivalent (as defined in AASB 107) unless the asset is restricted from being exchanged or used to settle a liability for at least twelve months after the reporting period.
An entity shall classify all other assets as non-current
Current Liabilities
An entity shall classify a liability as current when:
(a) it expects to settle the liability in its normal operating cycle;
(b) it holds the liability primarily for the purpose of trading;
(c) the liability is due to be settled within twelve months after the reporting period; or
(d) it does not have an unconditional right to defer settlement of the liability for at least twelve months after the reporting period (see paragraph 73 of AASB101). Terms of a liability that could, at the option of the counterparty, result in its settlement by the issue of equity instruments do not affect its classification.
Environmental performance licence or other authority / includes a consent, licence or permission or any form of authorisation
Minerals / As defined in Schedule 1 of Mining Regulation 2016(NSW)
Officer (and Company Officer) / Refer to section 9 of the Corporations Act2001 (Cth) limited to;
(a) director or secretary of the corporation; or
(b) a person:
(i) who makes, or participates in making, decisions that affect the whole, or a substantial part, of the business of the corporation; or
(ii) who has the capacity to affect significantly the corporation's financial standing
Other relevant legislation / Defined in Schedule 5 of the Mining Regulation 2016:
Commonwealth legislation
Environment Protection and Biodiversity Conservation Act 1999
Offshore Minerals Act 1994
Offshore Petroleum and Greenhouse Gas Storage Act 2006
Offshore Petroleum (Royalty) Act 2006
New South Wales legislation
Dams Safety Act 1978
Dams Safety Act 2015
Environmental Planning and Assessment Act 1979
Fisheries Act 1935
Fisheries Management Act 1994
Heritage Act 1977
Local Government Act 1993
Marine Estate Management Act 2014
Marine Pollution Act 2012
Mining Act 1992
National Parks and Wildlife Act 1974
Native Vegetation Act 2003
Offshore Minerals Act 1999
Petroleum (Offshore) Act 1982
Petroleum (Onshore) Act 1991
Soil Conservation Act 1938
Threatened Species Conservation Act 1995
Uranium Mining and Nuclear Facilities (Prohibitions) Act 1986
Water Act 1912
Water Management Act 2000
Water NSW Act 2014
Western Lands Act 1901
Northern Territory legislation
Environmental Assessment Act
Environmental Offences and Penalties Act
Heritage Act
Mining Management Act
Petroleum Act
Petroleum (Submerged Lands) Act
Planning Act
Waste Management and Pollution Control Act
Water Act
Queensland legislation
Aboriginal Cultural Heritage Act 2003
Environmental Protection Act 1994
Geothermal Energy Act 2010
Greenhouse Gas Storage Act 2009
Mineral Resources Act 1989
Nature Conservation Act 1992
Offshore Minerals Act 1998
Petroleum Act 1923
Petroleum (Submerged Lands) Act 1982
Regional Planning Interests Act 2014
Queensland Heritage Act 1992
Vegetation Management Act 1999
Water Act 2000
South Australian legislation
Aboriginal Heritage Act 1988
Development Act 1993
Environment Protection Act 1993
Heritage Places Act 1993
Mining Act 1971
National Parks and Wildlife Act 1972
Native Vegetation Act 1991
Natural Resources Management Act 2004
Offshore Minerals Act 2000
Opal Mining Act 1995
Petroleum and Geothermal Energy Act 2000
Petroleum (Submerged Lands) Act 1982
River Murray Act 2003
South Eastern Water Conservation and Drainage Act 1992
Water Industry Act 2012
Tasmanian legislation
Aboriginal Relics Act 1975
Environmental Management and Pollution Control Act 1994
Historic Cultural Heritage Act 1995
Land Use Planning and Approvals Act 1993
Mineral Resources Development Act 1995
National Parks and Reserves Management Act 2002
Nature Conservation Act 2002
Petroleum (Submerged Lands) Act 1982
Pollution of Waters by Oil and Noxious Substances Act 1987
Threatened Species Protection Act 1995
Water Management Act 1999
Victorian legislation
Environment Protection Act 1970
Extractive Industries Development Act 1995
Flora and Fauna Guarantee Act 1988
Geothermal Energy Resources Act 2005
Greenhouse Gas Geological Sequestration Act 2008
Mineral Resources (Sustainable Development) Act 1990
National Parks Act 1975
Petroleum Act 1998
Petroleum (Submerged Lands) Act 1982
Planning and Environment Act 1987
Pollution of Waters by Oil and Noxious Substances Act 1986
Underseas Mineral Resources Act 1963
Water Act 1989
Wildlife Act 1975
Western Australian legislation
Aboriginal Heritage Act 1972
Conservation and Land Management Act 1984
Contaminated Sites Act 2003
Environmental Protection Act 1986
Heritage of Western Australia Act 1990
Mining Act 1978
Offshore Minerals Act 2003
Petroleum and Geothermal Energy Resources Act 1967
Petroleum (Submerged Lands) Act 1982
Planning and Development Act 2005
Pollution of Waters by Oil and Noxious Substances Act 1987
Rights in Water and Irrigation Act 1914
Wildlife Conservation Act 1950
Serious offence / An offence committed in New South Wales that is punishable by imprisonment for life or for a term of 5 years or more or by a fine of $500,000 or more, or an offence committed elsewhere than in New South Wales that if committed in New South Wales would be an offence so punishable, or
An offence committed under a law of the Commonwealth that is punishable by imprisonment for life or for a term of 5 years or more or by a fine of $500,000 or more.
Related Body Corporate / Refer to section 50 of the Corporations Act 2001 (Cth) limited to
Where a body corporate is:
(a) a holding company of another body corporate; or
(b) a subsidiary of another body corporate
Ultimate Holding Company / Has the same meaning as defined by the Corporations Act 2001 (Cth). An ultimate holding company must be the holding company of another, and must not be a subsidiary of any other company.

PUB16/544 Version 1.4, June 20181