Retention Licence Application Form
Mineral Resources (Sustainable Development) Act 1990 (MRSDA)
ALL information required by Schedule 5 of the Mineral Resources (Sustainable Development) (Mineral Industries) Regulations 2013 must be provided or the application is invalid. Section 15 of the MRSDA also sets out additional requirements for Retention Licences.
The Ministerial Guidelines for describing a mineral resource must also be followed in making an application for a retention licence.
Question 1. Name and address of applicant(s) (if the applicant is a company, the registered address of the company)
1. Surname or Company name:
ABN (if applicable):
Date of Birth:
Number and street name:
(Do not show a Post Box Number. Must be registered office address if a company.)
Contact details and correspondence address (if not as above):
Applicant Employee Agent (Please tick one)
Position (if employee):
Address for correspondence:
Project name for this tenement (optional):
Note: ALL applicants (or the authorised agent) must sign at end of application.
Question 2: Applicant Company details
If the applicant is a company, please attach the following items to the application.
a list of the company directors and their dates of birth; and a copy of the certificate of registration of the company.
Question 3: Description of application area
1:25,000 Map Name(s):
A map of scale 1:25,000 or larger must be attached clearly showing the boundaries of private land and Crown land.
Attach information that demonstrates that the area of the land applied for is only that land which may be required for the purpose of mining a mineral resource in the future.
Question 4: Native Title
If the application includes Crown land, indicate which of the following options will be utilised to comply with the Commonwealth
Native Title Act 1993 (NTA) or the Traditional Owners Settlement Act 2010 (TOSA).
Excise all Crown land except those areas where native title has been extinguished (such as Roads and Road Reserves); Comply with the Right to Negotiate provisions of the NTA; Reach an Indigenous Land Use Agreement under the NTA; Comply with the relevant land use activity agreement under the TOSA (where applicable).
You must answer this question now if the application includes Crown land. (Refer to Application Kit)
Question 5: Does the application area lie within an Exploration Licence (EL) or a Prospecting Licence (PL) either granted or applied for?
Give licence number
If YES please tick the appropriate box below:
(The application is invalid if you cannot tick one of these questions below)
I/We are the holder(s)/applicant(s) of the EL/PL
A letter of consent from the EL/PL holder(s)/applicant(s) is attached
Question 6: Estimated expenditure and activities schedule for the life of the licence
Term of Licence being applied for: Years
Note: Only include activities and expenditure for the number of years you are applying for.
Projected extraction rate:
Attach information that demonstrates that the proposed expenditure is commensurate with the proposed program of work (refer Question 14 regarding program of work)
Question 7: Evidence of financial capacity to fund the estimated expenditure
Please ensure that supplied financial information is not more than 6 months old. 1. Company (with audited financial statements)
Note: All companies must attach their most recent audited financial report. All fields must be completed. Put N/A if not applicable.
2. Individual or Company (without audited financial report):
Note: All applicants must provide a current bank statement.
List of plant and equipment can only be included provided it is owned by the applicant and is to be used for activities on this application.
All fields must be completed. Put N/A if not applicable.
Question 8: Expertise of person(s), including the applicant, undertaking the retention licence activities
If the person is not an employee of the applicant you must attach evidence that he/she has agreed to assist in the proposed work program.
Question 9: Indicate your experience in exploration and mining activities
I/We currently or have previously held a minerals tenement in Victoria (within last 5 years) under the name given in Question 1 (No further details are required).
I/We have previously held a minerals tenement in Victoria (within last 5 years), under another name (Attach details).
I/We have previously held a minerals tenement outside Victoria (within last 5 years) (Attach details of location and type of most recently held tenements and describe operation).
I/We have not previously held a minerals tenement within last 5 years (Attach details of your knowledge and relevant mining/exploration experience).
Question 10: Indicate your experience in project evaluation and development activities
I/We currently or have previously developed a mining operation in Victoria (within last 5 years) under the name given in Question 1 (No further details are required).
I/We have previously developed a mining operation in Victoria (within last 5 years) under another name (Attach details).
I/We have previously developed a mining operation outside Victoria (within last 5 years) (Attach details of location and type of most recently held tenements and describe operation).
I/We have not previously developed a mining operation within last 5 years (If this is the case, please attach details of your knowledge of mining project evaluation and development and your ability to acquire relevant experience in project evaluation/development activities).
Question 11: Indicate with a tick whether any of the following apply to the applicant or associate
Has failed to undertake rehabilitation required under the MRSDA and the Minister has taken action to rehabilitate the land under section 83 of the MRSDA;
Has had a licence cancelled under the MRSDA;
Has been convicted of an offence against the MRSDA;
Has been convicted of an offence involving fraud or dishonesty;
Is insolvent under administration.
If one or more of the above are applicable to either the applicant or an associate of the applicant attach details outlining -
the name of the party and their relationship to the applicant;
the nature of the offence;
when the offence was committed; and
the penalty imposed (if applicable).
Note - an Associate is defined as a director, partner, trustee, executive officer, secretary or any other officer or person associated or connected with the ownership, administration or management of the applicant's business.
Question 12: Mineralisation Report
The mineralisation report must be submitted with the application.
The mineralisation report must include the exploration results in relation to the described mineral resource, including the:
Types of minerals identified;
Location, depth, quantity and extent of the minerals;
Method by which that extent has been determined;
Analytic results obtained from samples of those minerals; and
An analysis of whether exploration results indicate that there is reasonable prospect that mining of the described mineral resource will be economically viable.
The mineralisation report must also include, in accordance with the Ministerial guidelines, information to demonstrate that:
The mineral resource is not currently economically viable to mine; and
The mineral resource could become economically viable to mine in the future.
Refer to Guidelines for Description of a Mineral Resource in a Mining Licence or a Retention Licence Application.
Question 13: Competent Person
The mineralisation report must be prepared by a competent person.
The following information must also be submitted with the mineralisation report as evidence that it has been prepared by a competent person:
Contact details of the competent person who prepared the report;
Relevant professional organisation membership/s of the competent person who prepared the report;
Relevant experience of the competent person who prepared the report.
Question 14: Details of the program of work
Attach a program of work that supplements the work program summary detailed in question 6 by including the following information:
Nature of the intensive exploration program proposed (in-fill drilling, bulk sampling, etc) and an indication of the location and focus of the proposed exploration with location maps;
Mineral resource assessment and technical and/or economic studies related to the development of the mineral resource;
A time schedule for the work program including key milestones and proposed expenditure against each milestone;
Demonstration that the scale and outline of the proposed work and level of expenditure is commensurate with the size of the mineral resource.
Refer to Retention Licence Application Kit and the Retention Licence guidelines for specific details of Mineralisation Report and program of work requirements.
Question 15: Primary mineral to which the application relates
Base metals (copper, lead, zinc)
Question 16: Description of mineral resource
Section 15(1BB) of the MRSDA requires that the application describes the mineral resource in accordance with the guidelines issued by the Minister. Attach a description of the mineral resource, in accordance with the Ministerial guidelines and indicate whether that description refers to a:
JORC inferred mineral resource; or
JORC indicated mineral resource; or
Alternative mineral resource standard as provided in the Ministerial guidelines.
Question 17: Preferred annual reporting date (choose one of the following dates)
Question 18: Application Fee
Application for Retention Licence fee of $
Note: The application must be accompanied by the prescribed fee. Refer
Fees and charges
Question 19: Survey of land applied for
Section 15(1BH) of the MRSDA requires that the application must include a survey of the boundary of the land proposed to be covered by the licence in accordance with Division 3A.
Attach a survey of the land proposed to be covered by the licence:
I/We declare that to the best of my/our knowledge, all the information I/we have given is true and correct.
Indicate with a tick, the attachments you are submitting with the application:
Map according to the Geocentric Datum of Australia 1994 (GDA94) labelled with MGA (Map Grid of Australia) coordinates showing area covered by application
List of Directors and their Date of Birth details, of the applicant Company (if applicable)
Copy of Certificate of Registration of applicant Company (if applicable)
Evidence of authorisation from applicant for agent to act on their behalf (if applicable)
Description of Mineral Resource (as per Ministerial guidelines)
Work program details
Statement by non-employee advisors of agreement to act as advisors for this application (if applicable)
Written consent from EL/PL holder/applicant over application area (if applicable)
Survey of the land proposed to be covered by the licence
Other attachments (give details below)
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 DEDJTR 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.
Opening hours: Monday to Friday 9:00am to 4:30pm.
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 MRSDA or a relevant Act. Limited information may be available to the public for the purpose of land use advice.
You must submit this application to:
The Earth Resources Information Centre
Level 15, 1 Spring Street, Melbourne, 3000
Opening hours: Monday to Friday 9:00am to 4:30pm
(GPO Box 2392, Melbourne VIC 3001)
Ranking is given according to the day the application is received by the Earth Resources information Centre. Office Use Only
Delivered: In person / By post
Retention Licence no: