Applicant details Sample Clauses
Applicant details. To apply for an amendment to a permit you must be the current holder of the existing permit. Include Australian Company Number (ACN) if the proposed permit holder is a body corporate or other entity formed at law. Are you applying as an individual, a company or incorporated body? Enter details for one only. An individual Title Mr ☐ Mrs ☐ Ms ☐ Other: Name/s A body corporate or Silver Lake (Integra) Pty Ltd other entity formed at law (include ACN) ▇▇▇▇▇▇▇▇▇ If applying as a company or incorporated body, please also supply the registered business office address. DWER and DMIRS prefer to send all correspondence electronically via email. We request that you consent to receiving all correspondence relating to instruments and notices under Part V of the EP Act (“Part V documents”) electronically via email by indicating your consent in this section of the application form. Where ‘yes’ is selected, all correspondence from DWER or DMIRS (as applicable) will be sent to you via email, to the email address provided in this section. Where ‘no’ has been selected, Part V documents will be posted to you in hard copy to the postal/business address you have provided in this section. Other general correspondence may still be sent to you via email. Provide contact details for the above individual or body corporate. Contact person (and ▇▇ ▇▇▇▇▇▇ position, if applicable) Environment Manager Company name Silver Lake Resources Limited (if applicable) Postal / business PO Box 876; address South Perth WA 6951 Phone (fixed line): 63133800 Phone (mobile): ▇▇▇▇▇▇▇▇▇▇ Email address ▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇.▇▇ I consent to all written correspondence between myself (the applicant) and DWER/DMIRS (as applicable), regarding the premises which is the subject of this application, being exclusively via email, using the email address I have provided above. Yes No ☒ ☐ If different from the applicant’s contact details, enter the contact details of a person with whom DWER or DMIRS should liaise with concerning this clearing application. Where contact details differ to those of the applicant, complete the below section: Contact person (and position, if applicable) Company name (if applicable) Postal / business address Phone (fixed line) Phone (mobile) Email address
Applicant details. The title of the research project is requested. The application should be in the name of the principal worker. Affiliation, position, address, phone and mail should be added. In addition, name surname and affiliation of all the field assistants should be listed. Furthermore, state if any locally-based fieldworker(s) or scientist(s) has been engaged in the research activity. If so, please provide the personal details. Be aware that it is essential that the licence must be carried at all times by those engaged in the work, as evidence that the work being carried out is legitimate.
Applicant details. (Refers to the detail of the person requesting the change.) Please supply the contact detail of the person to whom the processed application must be returned.
Applicant details. An Agent could be one of the following: Architect, Engineer, Lessee, Developer, Prospective Purchaser, Building Practitioner, Urban Planner, and Agent for Contractor etc. (
Applicant details. Please read Notes 2 and 3 to ensure this page of the form is completed correctly a Company/organisation name b Title (e.g. Mr, Mrs, Miss, Ms) c First name d Last name e Contact address f Contact telephone number g Contact email address h Landlord registration number
Applicant details. Title: Mr, Mrs, Miss Dr, Rev, Other
Applicant details. Name of applicant: ABN (if applicable): Name of authorised person (if Applicant is an organisation): Address: Email: Mobile: Date: Signature of applicant:
Applicant details. Applicant’s name:
Applicant details. Title: Mr Mrs Ms Dr Prof ▇▇▇▇▇▇▇: First name/s: ID number: Date of birth: Gender: Male Female Race: Black African Black Coloured Black Indian White Nationality: Citizen status: D - Dual (SA plus other) O - Other PR - Permanent Resident SA - South Africa Home language: Disability status: None Hearing Impaired Disabled but unspecified Physical Sight Impaired Multiple Communication Impaired DECLARATION BY STUDENT RELATING TO APPLICATION FOR ADMISSION AND THE ENROLMENT CONTRACT I, the undersigned applicant, do hereby:
a) Acknowledge that I understand the provisions of the declarations herein and am bound by the provisions
b) Acknowledge that I have familiarised myself with the prospectus of the relevant programme for which I have applied to register and certify that the information provided in this form is accurate and complete.
c) Confirm that I have to satisfy the requirements of due performance as laid down by MANCOSA.
d) Hold myself responsible for the payment of full tuition fees relating thereto, notwithstanding the fact that my employer/sponsor has undertaken to pay the full tuition fees relating thereto.
e) Agree that where tuition fees are payable to MANCOSA in instalments, failure to pay any single instalment timeously will result in the full amount owing becoming due and payable immediately.
f) Agree that MANCOSA shall be entitled to recover from me all legal costs incurred in order to enforce its rights under this contract, including, but not by way of limitation, attorneys and own client fees and collection charges and all tracing charges.
g) Agree that MANCOSA reserves the right to withhold programme/module results should there be any default
h) Accept that if I choose a payment plan, I am in a position to fulfil my financial obligations to MANCOSA.
i) Accept that I may cancel my registration for the current year of study as a whole and shall be exonerated from the liability for the full fee (excluding the registration fee) provided that MANCOSA is informed in writing within 14 days of registration.
j) Agree that MANCOSA may approach credit agencies with a view of ascertaining my credit record and that in the event of me being in arrears with this account or
k) Agree that should my account not be settled within the stipulated date my chosen plan option will be converted to plan 3. Non-settlement of plan 3 will attract a penalty.
l) Acknowledge that a certificate issued by MANCOSA , shall be proof of the full amount owing by the student for the pu...
Applicant details. To apply for an amendment to a permit you must be the current holder of the existing permit. Include Australian Company Number (ACN) if the proposed permit holder is a body corporate or other entity formed at law. Are you applying as an individual, a company or incorporated body? Enter details for one only. An individual Title ☐ Mr ☐ Mrs ☐ Ms ☐ Other: Name/s A body corporate or Greenmount Resources Pty Ltd (ACN: 604 613 650) other entity formed at law (include ACN) If applying as a company or incorporated body, please also supply the registered business office address. All written correspondence from the Department of Water and Environmental Regulation (DWER) or Department of Mines, Industry Regulation and Safety (DMIRS) regarding your application will be made via email. You must provide a valid email address through which you agree to accept all electronic correspondence. The postal/business address supplied must be a physical address to which a statutory notice under the EP Act may be delivered.1 Provide contact details for the above individual or body corporate. Contact person (and position, if applicable) Company name (if applicable) Postal / business address Phone (fixed line): Phone (mobile): Email address If different from the applicant’s contact details, enter the contact details of a person with whom DWER or DMIRS should liaise with concerning this clearing application. Where contact details differ to those of the applicant, complete the below section: Contact person (and position, if applicable) Company name (if applicable) Postal / business address Phone (fixed line) Phone (mobile) Email address 1 The provision of a postal/business address is required as any statutory notices or directions under the relevant legislation are required to be served by post or personally [sections 75 and 76 Interpretation Act 1984 (WA)].