EOD1 - Environmental Offsets Delivery Form 1: Notice of ...



Environmental Offsets Act 2014EOD1: Environmental Offsets Delivery Form 1 – Notice of ElectionThis form is an approved form under section 92 of the Environmental Offsets Act 2014. For all environmental offset applications you must:Complete this form (Environmental Offsets Delivery Form 1 – Notice of Election);Complete any other forms relevant to your application; andProvide any other mandatory supporting information relevant to your application as directed.This form is necessary for all environmental offset applications, except for advanced offset applications.Parent application details (e.g. Development Application or Environmental Authority)Administering agency reference number (permit/licence or authority number) FORMTEXT ?????Application categorySelect from drop-down list: Choose an item. Project name FORMTEXT ?????Offset stage number (if applicable) FORMTEXT ????? of FORMTEXT ?????Notice of electionThis notice is issued by the applicant to the agency responsible for the administration of environmental offsets in Queensland pursuant to section 18 of the Environmental Offsets Act 2014 to provide notice of election.This form provides official notification that an offset condition for a prescribed activity pertaining to the case reference listed in Part 2 of this form will be met by the authority holder by way of the following offset delivery mechanism: (select one)? A proponent-driven offsetI have attached the following supporting documents:? Environmental Offsets Delivery Form 2 – Offset Delivery Plan? Environmental Offsets Delivery Form 3 – Offset Area Details? Environmental Offsets Delivery Form 5 – Habitat Quality Details (not required for SEQ koala habitat tree counts)? Environmental Offsets Delivery Form 6 – Staged Offset Details (only applicable for staged offsets)? A financial settlement offsetI have attached the following supporting documents:? Environmental Offsets Delivery Form 4 – Financial Settlement Details? A combination of a proponent-driven offset and a financial settlement offsetTo work out your breakdown of proponent-driven and financial settlement offsets, please use the Combined Offsets Delivery Calculator.I have attached the following supporting documents:? Environmental Offsets Delivery Form 2 – Offset Delivery Plan? Environmental Offsets Delivery Form 3 – Offset Area Details? Environmental Offsets Delivery Form 4 – Financial Settlement Details? Environmental Offsets Delivery Form 5 – Habitat Quality Details (not required for SEQ koala habitat tree counts)? Environmental Offsets Delivery Form 6 – Staged Offset Details (only applicable for staged offsets)Applicant declarationBy signing this applicant declaration:? I do solemnly and sincerely declare that I am the authority holder (or authorised agent to act on behalf of the authority holder).? I do solemnly and sincerely declare that the information I have provided is true and correct to the best of my knowledge.? I understand that all information supplied in or with this application form may be disclosed publicly in accordance with the Right to Information Act 2009 and the Evidence Act 1977.? I understand that if I have not told the truth in this application I may be liable for prosecution under the relevant Acts or Regulations.Name (individual or principal contact if applicant is an organisation) FORMTEXT ?????Organisation name (if applicant is an organisation) FORMTEXT ?????ACN/ABN (if an organisation) FORMTEXT ?????Postal address FORMTEXT ?????Phone FORMTEXT ?????Mobile phone FORMTEXT ?????Email address FORMTEXT ?????Signature (print and sign or insert as image)Date FORMTEXT ?????Notes FORMTEXT ?????Submitting a notice of election applicationTo submit a notice of election application for assessment purposes, ensure all relevant parts of the form have been filled in correctly and forward it together with any mandatory attachments to the relevant administering agency responsible for administering the offset condition.Pre-lodgement meetingsFor pre-lodgement advice, please lodge an application to the State Assessment and Referral Agency. To request a pre-lodgement meeting with the Department of Environment and Science to discuss the details of your notice of election, please fill in and submit the pre-design/pre-lodgement application form.Further informationFor further information about environmental offsets, please email offsets@des..au. To discuss a current offset application, please phone 13 QGOV (13 74 68).Office use onlyAdministering agencyAdministering Agency: Choose an item.Technical assessment agency detailsAgency name: Choose an item.Region: Choose an item.Service centre: Choose an item.Officer: FORMTEXT ?????Received date: FORMTEXT ?????Recommendation due date: FORMTEXT ?????Recommendation made date: FORMTEXT ?????Details entered in offsets register? (Yes/No) FORMTEXT ?????Notes FORMTEXT ????? ................
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