Application for production lease (tender)
Greenhouse Gas Storage Act 2009,
Petroleum and Gas (Production and Safety) Act 2004
Form MMOL-15A Version 1
You may complete the original of this application and submit the application, any attachments and the prescribed fee at office listed in
the tender document. A tender application is to be lodged in accordance with the instructions contained in the relevant tender
document.
Note: A document containing information that is false or misleading may attract a maximum penalty of up to 500 penalty units.
Please use a pen, and write neatly using BLOCK LETTERS Cross where applicable
form, attach a separate page.
. Where insufficient space anywhere on this
Question 1 – Permit details
Petroleum
Land release number PLR:
Greenhouse Gas
Land release number GLR:
Permit application
name:
Term of permit:
years
General locality of the
application:
Question 2 – Permit holder details (if more than two holders provide a separate attachment in format below)
2.1 Authorised holder (Principal holder)
Company name /
surname:
Given name
(if individual):
Address:
ACN/ARBN:
Town/City:
State:
Country:
Phone no.:
Postcode:
Email:
Sole tenant
Percentage holding:
%
OFFICE USE ONLY
Fees paid:
Payment Method:
Receipt Number: ________________
Received at: ________________
Received by:
Total $ _______
Cash
DNRM
Credit Card
Date:
NT AD
EFTPOS
Receiving officer
I confirm that:
•
the details on application form have been checked;
•
all attachments have been submitted;
•
correct application fees have been submitted for the
relevant application type.
Name: ___________________________
Time:
/
/
AM/PM
Cheque
Signed:___________________________ Date:
Name:
January 2017
Date:
/
/
/
/
Page | 1
2.2 Other holders (if applicable)
Company name /
surname:
Given name
(if individual):
Address:
ACN/ARBN:
Town/City:
State:
Country:
Phone no.:
Postcode:
Email:
Tenants in common
Joint tenants
Percentage holding:
%
2.3 Authorised holder representative (authorised person to act as contact for this permit)
Name:
Contact:
Address:
Town/City:
State:
Country:
Phone no.:
Postcode:
Email:
Attachments required:
•
Proof of identity for each holder e.g. Company certificate issued by ASIC, drivers licence (for individuals)
•
Letter of authority from holders for authorised holder representative to act on behalf of holders for
this permit (not required if applicant is an individual (not company) and representing themselves).
Further information is available in the Authorised holder representative guideline available on the website
•
A proposed development plan complying with the initial development plan requirements
•
(Where applicable) Details that address the special criteria
•
A statement about the extent to which the applicant has the ability to manage production or GHG
steam storage
•
A statement detailing why the size of the proposed area of the lease is appropriate for authorised
activities under the lease.
February 2017
Page | 2
•
Details about each tenderer’s ability to meet the capability criteria.
o Indicate the experience of each applicant in exploration and production, addressing whether each
applicant:
o Currently holds a resources tenure; or
o Has previously held a resources tenure within Queensland; or
o Has previously held, or currently holds a resources tenure outside Queensland; or
o Has not previously held a resources tenure.
(If an applicant currently holds a resource tenure, or has previously held a resources tenure, please attach
details of this tenure. If an applicant has never held a resource tenure, please attach details of the directors
and their experience in running companies previously under their directorships, or attach a general summary
containing details of the applicant’s previous work history.)
•
Detail each applicant’s own financial resources, or of the financial resources readily available to each
applicant
•
Detail each applicant’s own technical resources, or of the technical resources readily available to each
applicant.
•
(Where applicable) Any other relevant matters stated in the call for tender
Additional requirements for an application to tender for a Petroleum Lease
(Refer to tender document to determine if these requirements are listed. If not, please attach to
application)
Evidence establishing one of the following matters:
•
Petroleum will be produced commercially, or is likely to be produced commercially within 2 years after the
lease is to take effect; or
•
The applicant has entered into a contract or coordination arrangement that binds the applicant to supply
petroleum produced from the proposed permit area and lodged a written declaration that the petroleum
produced from the area of the lease will meet all or some of the petroleum required to be supplied under
the relevant arrangement; or
•
The proposed permit area applied for is suitable for natural underground reservoir storage and the
storage will, or is likely to, start within the later of the following happening:
o The end of 5 years after the lease is to take effect;
o The end of the plan period for the applicant’s proposed development plan for the lease
•
If the proposed authorised activities relate to petroleum production—include a statement by a suitably
qualified person that the proposed area contains commercial quantities of petroleum
•
Application overlapping with Geothermal or GHG tenure- A statement that complies with s392AF (an
information statement) and other information addressing the assessment criteria detailed in s292AE
Additional requirements for an application to tender for GHG
(Refer to tender document to determine if these requirements are listed. If not, please attach to
application)
•
Provide a statement addressing the notification requirements to each owner and occupier. How and when
the applicant proposes to consult with and keep informed each owner and occupier of private and public
land on which authorised activities for the proposed GHG lease are or are likely to be carried out.
Question 3 –Obligations and declaration
WARNING: Giving false or misleading information is a serious offence.
•
•
•
•
I have read and understood the Petroleum lease and other relevant guides.
I understand my obligations as an applicant/holder for a petroleum lease.
I have truthfully declared all relevant details requested of me in this application.
If any part of this form has been completed with the assistance of another person, I declare that the information as set
down is true and correct and has been included with my full knowledge, consent and understanding.
• If a company, this application is signed in accordance with the Corporations Act 2001
February 2017
Page | 3
Print name:
Signature:
Position:
Date:
Company:
Print name:
Signature:
Position:
Date:
Company:
Print name:
Signature:
Position:
Date:
Company:
Print name:
Signature:
Position:
Date:
Company:
Question 4 – Payment
Note: Q4 refer to the relevant tender document for more information about payment
Permit application
Application fee
Tenders are to be lodged in accordance with the
instructions contained in the relevant tender
document
Disclaimer
The Queensland Government is collecting information provided on and with this form to assess the suitability of the application for
petroleum lease under sections 118, 128, 351 of the Petroleum and Gas (Production and Safety) Act 2004 (the Act), section 114 of the
Greenhouse Gas Storage Act 2009 and section 197 of the Mineral and Energy Resources (Common Provisions) Act 2014 (MERCP).
Some or all of this information may be provided to other agencies of the Queensland Government for issuing an environmental
authority, to make register searches, extracts or copies or to make other approvals as required under the relevant Act. Your personal
information will not otherwise be disclosed to any other third party without your consent, unless authorised or required by law.
February 2017
Page | 4