Waterfowl hunting application - Northern Territory



Questions are followed by answer fields. Use the ‘Tab’ key to navigate through. Replace Y/N or Yes/No fields with your answer.Territory Parks and Wildlife Conservation Act 1976Before you applyHunting of waterfowl is only permitted during the gazetted open season each year. There are daily bag limits and restrictions on the number of waterfowl you can have in your possession at any one time. There are also restrictions on the types of weapons and shots that can be used. Read about hunting rules and permit conditions on the .au website. All fields are required unless noted. Applicant detailsThe applicant will be the permit holderGiven name/sFamily nameDate of birthPhoneEmailResidential addressPostal address (if different from residential)Emergency contactFull namePhonePermit detailsHow long do you want your waterfowl hunting permit for?? 1 year - $20? 5 years - $80What weapons will you be using to hunt? Select all that apply.? Hunting bow? FirearmAre you proposing to hunt for waterfowl on private land? If yes, you must have express permission of the landowner. This permission must be granted each season. ?Yes/NoShooters licence detailsComplete this section if you have proposed to hunt with a firearm. You must also attach a copy of your shooters licence. This will be deleted once your application is processed.Shooters licence numberWhat date does your shooters licence expire? Which state was your shooters licence issued in? Nominee detailsA nominee is someone who can hunt under the direct supervision of the permit holderDo you want to include any nominees on this permit? You can include a maximum of 2 nominees. Junior nominees must be over 12 years of age and under 18 years of age.Yes/NoNominee 1Which best describes nominee 1? ? A child that you are the parent or legal guardian of? A child whose parent or legal guardian approves the child's inclusion as a nominee on the permit. You must attach written permission to this application. The template to use can be found on the .au website.? A non-resident of AustraliaGiven nameFamily name Date of birth Residential address Nominee 2Which best describes nominee 2? ? A child that you are the parent or legal guardian of? A child whose parent or legal guardian approves the child's inclusion as a nominee on the permit. You must attach written permission to this application. The template to use can be found on the .au website.? A non-resident of AustraliaGiven name Family name Date of birth Residential address Relevant convictions and declarationIn the last 5 years, have you been found guilty of any offence:under the Territory Parks and Wildlife Conservation Act 1976under the Firearms Act 1997under the Weapons Control Act 2001in the Northern Territory or elsewhere that relates to firearmsin the Northern Territory or elsewhere that relates to animals or wildlife?Yes/NoIf yes, provide details of the offence and outcomesRelease, waiver and indemnityIn the following paragraphs references to the “Commission” are to the Parks and Wildlife Commission of the Northern Territory, references to the “Corporation” are to the Conservation Land Corporation and references to the “Territory” are references to the Northern Territory of Australia.You must agree to all of the below: As a condition of the permit to which this application relates, I release, indemnify and grant a waiver to the full extent permitted by law, the Commission, the Corporation and the Territory are excluded from liability and will not be responsible for any loss, damage or injury that is sustained by me as a result of or in connection with the hunting activities carried out under the permit to which this application form relates, no matter how that loss, damage or injury is caused.Further, but only to the extent permitted by law, none of the Commission, the Corporation or the Territory will be responsible for loss, damage or injury sustained by me arising from any negligent act or omission by one or more of them or by any person for whom they are responsible.I release and indemnify to the full extent permitted by law, the Commission, the Corporation and the Territory and their respective officers, employees, agents, contractors, visitors and invitees from all responsibility or liability for any loss, damage, claims, demands and proceedings arising from or connected with the hunting activities carried out under the permit to which this application relates and in particular (but not limited to):my (or my nominee/s) presence in the park or reserve to which this application form and any permit granted to me relatesany breach of the permit by my nominees or myselfany unlawful act, default or omission on my part, the part of my nominees or any other person present in the park or reserve to which the Permit relatesloss, destruction or damage to real or personal propertyinjury to and death of any person, including my nominees and myself.I declare that all of the information I have included in this form is true and correct. I understand that it is an offence to wilfully make a false or misleading statement in connection with a matter under the Territory Parks and Wildlife Conservation Act 1976 (section 114) and significant penalties apply in relation to such offences.Signature By signing this form you agree to be bound by the waiver, indemnity and release in substantially the same terms set out above that will be included in the permit.DateSubmitEmail your completed form to pwpermits@.au.FeeThe permits office will contact you to discuss fee payment. Privacy Parks and Wildlife Commission respects and is committed to safeguarding the confidentiality and privacy of the information that it collects and handles, in accordance with the?Northern Territory Information Act 2002. You have been asked to provide personal information as part of your application to obtain a permit. You do not have to provide your personal information but if you choose not to, the department may be unable to accept or process your application, or your application may be refused.We will only use personal information supplied by you to provide a department service or program. We may share your information:with Land Councils, park or reserve management boards or committees and other government departments regarding your applicationif required or authorised by law to do soif you have given us your consent to share your personal information for a specific purpose.Find out more about how we handle your personal information by reading our privacy policy.Contact Parks and Wildlife Division Level 4 Goyder Centre25 Chung Wah TerracePalmerston NT 0830 Postal addressPO Box 496Palmerston NT 0831Phone: 08 8999 4795Fax: 08 8999 4524Email: pwpermits@.auEnd of form ................
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