(Do not show a Post Box Number. Must be registered office address if a company.)
Note: If more than two applicants please attach details on a separate page.
Personal information provided by you for the purpose of your application and
any related purpose (including the issue of a licence) is collected, used and
stored by the department to assist in the performance of duties under the MRSDA.
You have the right of access to this information by contacting the Earth Resources
Information Centre, Department of Economic Development, Jobs, Transport and Resources, Level 15, 1 Spring Street, Melbourne VIC 3000
The information may be disclosed to the Victoria Police, the Australian Securities
and Investments Commission and other government organisations for the purpose
of administering or enforcing the Act or a relevant Act. Limited information
may be available to the public for the purpose of land use advice.
Office Use Only
Delivered: In person / By post
Exploration Licence no:
|YOU MUST SUBMIT
THE EARTH RESOURCES
LEVEL 15, 1 SPRING ST
MELBOURNE VICTORIA 3000
(GPO BOX 2392,
MELBOURNE VICTORIA 3001)
RANKING IS GIVEN ACCORDING TO
THE DAY THE APPLICATION IS RECEIVED
THE EARTH RESOURCES INFORMATION CENTRE