In partnership with
ABN: 27 811 602 364
IRRIGATION EFFICIENCY INCENTIVES PROGRAM
2017/18
EXPRESSION OF INTEREST FORM
PUR 011 FORM
INSTRUCTIONS

Due date of lodgement of this form is no later than 17 July 2017. If your completed Expression of
Interest Form (including all attachments e.g. map, quotes, system check report and water use figures)
is not received by this date it will not be considered for this round.

Please discuss the prerequisites, conditions and confirm eligibility with your Department of Economic
Development, Transport, Jobs and Resources contact person (listed below) before filling out this form.

Complete and lodge a separate Expression of Interest (EOI) form for each property requiring an
incentive. Only EOIs with ALL information received by 17 July 2017, will be accepted.

Please post or lodge this form in person with required attachments to:
Maxine Schache
Re: Irrigation Incentive Expression of Interest Form
Department of Economic Development, Transport, Jobs and Resources
In person
Cnr Eleventh St & Koorlong Ave
Irymple
OR
Post
PO Box 905
Mildura VIC 3502
For further information, contact:
Maxine Schache
Irrigation Extension Officer
Metadata
Phone 03 5051 4500
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 1 of 7
CLIENT DETAILS (please print using a black or blue pen)
Full name
Business Name
ABN
Postal address
Suburb / Town
Postcode
Phone Number
Fax Number
Mobile Number
Email Address
Property Detail
Lot & Plan No. or Crown
Allotment ID
Road Location & Block
Number
Area Applicable to
Incentive (Ha)
Property size (Ha)
Irrigation district
Are you the sole
owner of the
property?
Yes
No – select one:
Co-own
Lease
Share
Other (please describe):
Name
Property Owner
Details
(If not sole owner)
Address
Phone Number
Please attach a map of your property detailing the patch(s) where your intended works will take place.
Please make sure this map has roads and landmarks marked so that it is easily recognised (see
Guidelines for an example).
Metadata
Note: Please consider your incentive application in the context of the overall plan for your business, and consult
your business advisers and/or accountant for professional advice.
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 2 of 7
CURRENT PRACTICE
1.
Please list your current irrigation system type/s and crop type/s located on the area applicable to the
incentive
Crop Type (variety)
2.
Age (Years)
Area(Ha)
Irrigation System Type
Have you completed a systems check on the relevant area? Please tick the box.
Yes
No
Please attach the copy of the full system check report including auditor comments and recommendations.
CLIENT GOALS
3.
Which incentive type/s are you applying for? Please tick the box/es (select all that apply).
Systems Check
Irrigation and Drainage Management Plan
Scheduling Equipment
Systems Upgrade
If applying for a system upgrade provide details of the proposed changes.
Crop Type (variety)
4.
Area(Ha)
Irrigation System Type
Please list your intended project activities.
.…………………………………………………………………………………………………
…………………………………………………………………………………………………
5.
What is the total quoted amount you would require to achieve your project goals?
$………………………………………………
Please attach a copy of the relevant quote/s.
6.
What is your approximate timeline for achieving your intended activities?
Metadata
.………………………………………………………………………………………………..
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 3 of 7
INCENTIVE INFORMATION
7.
If you have requested scheduling equipment as the incentive type desired, is the equipment in conjunction
with a system upgrade? Please tick the box.
Yes
8.
No
Do you possess existing information on irrigation benchmarking relevant to the incentive area? Please tick
the box.
Yes
No
If yes, what was your irrigation benchmarking application efficiency level?
<50%
50% - 84%
85% - 95%
>95%
9. Please attach your water use figures for 2012-13, 2013-14 and 2014-15 (the minimum information required
is your annual use figures).
Did you water all of your block each year?
Yes
No
If not, what area was watered? Year ………………. Ha……………….
10. To the best of your knowledge, have you, or any previous owners of this property received any government
irrigation incentive/s for works on this property?
Yes
No
If yes, please specify what incentive(s) and what year this occurred (if known)
……………………………………………………………………………………………………………..
11. Have you applied for funds under the On-Farm Irrigation Efficiency Program for this property?
Yes
No
If yes, please specify what year ………………………………………………………………..
Were you successful?
Yes
No
12. To the best of your knowledge, have you, or any previous owners of this property participated in the
Australian Government’s Small Block Irrigation Exit Grant?
Yes
No
SCHEDULING EQUIPMENT DETAILS (complete if ONLY applying for scheduling equipment)
Metadata
Additional information is needed to process the applications for the Scheduling Equipment Incentive.
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 4 of 7
CURRENT PUMP AND SYSTEM DETAILS
13. Pump Output pressure? ……………………………………………………
14. Suction Head (in metres)? …………………………………………………..
15. Emitter Row spacings? ……………………………………………………...
16. Emitter spacing within the row? ……………………………………………
…………………KPa
17. Emitter pressures (at least 1 needed)?
…………………KPa
…………………KPa
…………………KPa
18. Typical flow rate (mm/min)? ……………………………………………….
CROP DETAILS
19. Crop variety (ie. Sultana, Crimson, Navel)?………………………………
20. Crop Age? …………………………………………………………………..
21. Rootstock variety? …………………………………………………………
22. Row spacings? ……………………………………………………………..
23. Tree/Vine spacings? ……………………………………………………….
24. Rootzone depth (if known)? ………………………………………………
25. RAW (if known)? …………………………………………………………..
FURROW IRRIGATION DETAILS (complete if applicable)
26. Number of furrows down each row?………………………………………
27. Width of furrows? ……………………………………………………………
28. Length of furrows? …………………………………………………………..
29. Furrow distribution (ie. every row, every 2 nd row)? ………………………
30. Depth of wetting? ……………………………………………………………
IRRIGATION RECORDS
Please attach your irrigation records (including date, duration and amount used) for every irrigation over the
2014-15, 2015-16 and 2016-17 seasons. Instructions on how to obtain your irrigation records over the
internet can be found in the guidelines.
IRRIGATION MANAGEMENT TRAINING
31.
Have you attended an irrigation management course or refresher course in the last three years?
Yes
No
If yes, name of course: …………………………………………………………………….
Metadata
Date of completion: …………/…………/…………
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 5 of 7
(OFFICE Copy)
DECLARATION
I, ………………………………………………………… have read and understand the prerequisite(s) and condition
guidelines that support this form. I declare that the information given in this claim for incentives is correct. I
understand that deliberately giving false or misleading information is a serious offence which will automatically lead
to the cancellation of any incentive; and, that the Mallee Catchment Management Authority can substantiate the
information contained within. Failure to complete this form will render this application ineligible for the described
incentives.
I understand personal information is protected under the Victorian Information Privacy Act 2000. The purpose of
collecting the information on this Expression of Interest form is to process your application for an irrigation incentive.
The expressions of interest are to be prioritised and therefore incentives are not guaranteed until I receive official
notification. I agree, that if allocated incentives that I will not claim for the planned works from any other source.
If my application is successful, I am unable to transfer this incentive to any other part of my property for any other
works other than the incentive I am given, nor can I transfer this incentive to any other property I might own.
Please contact your Case Manager if you wish to review this application.
Incentives are not transferable either to another property or to another incentive type.
CHECK LIST
Completed ALL questions
Attached Quotes
Attached Water Use Figures
Map which easily identifies your property (include road names, exactly where your
property is and area of incentive)
Attached System Check Reports (if already available)
Benchmarking Scores (if appropriate)
Permission from Property Owner/s obtained
Signed by the person applying for the incentive:
……………………………………………………………(Applicant Name - print)
……………………………………………………………(Signature)
Date: ………/………/………
Acknowledgement of receipt Grants/Incentives Registration Number:
Date EOI Received: ………/………/………
Metadata
Case manager signature: ………………………………
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 6 of 7
(YOUR Copy)
DECLARATION
I, ………………………………………………………… have read and understand the prerequisite(s) and condition
guidelines that support this form. I declare that the information given in this claim for incentives is correct. I
understand that deliberately giving false or misleading information is a serious offence which will automatically lead
to the cancellation of any incentive; and, that the Mallee Catchment Management Authority can substantiate the
information contained within. Failure to complete this form will render this application ineligible for the described
incentives.
I understand personal information is protected under the Victorian Information Privacy Act 2000. The purpose of
collecting the information on this Expression of Interest form is to process your application for an irrigation incentive.
The expressions of interest are to be prioritised and therefore incentives are not guaranteed until I receive official
notification. I agree, that if allocated incentives that I will not claim for the planned works from any other source.
If my application is successful, I am unable to transfer this incentive to any other part of my property for any other
works other than the incentive I am given, nor can I transfer this incentive to any other property I might own.
Please contact your Case Manager if you wish to review this application.
Incentives are not transferable either to another property or to another incentive type.
CHECK LIST
Completed ALL questions
Attached Quotes
Attached Water Use Figures
Map which easily identifies your property (include road names, exactly where your property
is and the area of incentive)
Attached System Check Reports (if already available)
Benchmarking Scores (if appropriate)
Permission from Property Owner/s obtained
Signed by the person applying for the incentive:
……………………………………………………………(Applicant Name - print)
……………………………………………………………(Signature)
Date: ………/………/………
Acknowledgement of receipt Grants/Incentives Registration Number:
Date EOI Received: ………/………/………
Metadata
Case manager signature: ………………………………
Approved by
Owner / Custodian
Date of First Issue
Current Version
Search terms
MCS
MCS
July 2016
V1.0
Expression of interest, grant, incentive, irrigation
Last Updated
Replaces
Review Date
Review Trigger
July 2016
N/A
June 2018
CMA 050 PRO
Reference PUR 011 FORM
Page 7 of 7