Schedule 1 |
Form 1 |

Applicant details*
Full name of applicant:
Address for service:
Email address:
Full name and telephone number of general contact person for application:
Full name and telephone number of financial contact person for application:
Full name, telephone number and email address of geotechnical contact person for application:
Type of applicant:
Incorporated society/overseas company/partnership/charitable trust/registered company/local authority/industrial and provident society/Crown/other [state type]
Applicant’s New Zealand Companies Office number (if applicable):]†
*The personal information you must include in this form is needed to process your application under the Crown Minerals Act 1991. You have the right under the Privacy Act 1993 or the Official Information Act 1982 to access this information and request that it be corrected.
† The unique number assigned to the company on its incorporation.
Permit details
Permit type to which application relates:
Permit number (if application for subsequent permit):
Minerals to which permit relates:
If this is a prospecting application, is a non-exclusive permit sought?
Yes/No
Duration: (years) (months)
Area: (hectares/square kilometres)
Location: (region)
Onshore: Yes/No
Application fee
Cash
Credit card
Cheque
Direct debit
Direct credit
Supporting information
Please send with your application the prescribed fee required under the Crown Minerals (Minerals Fees) Regulations 2006 for an application of this type (or evidence of it having been paid) and any information that is required under the Crown Minerals (Minerals and Coal) Regulations 2007 to accompany an application of this type.
Authorised signature*
Authorised signature(s):
Print name:
Position of signatory:
Date:
*If made by 2 or more persons, this application must be signed in accordance with regulation 6 of the Crown Minerals (Minerals and Coal) Regulations 2007.

Form 2 |

Permit holder details*
Full name of permit holder:
Permit number:
*The personal information you must include in this form is needed to process your application under the Crown Minerals Act 1991. You have the right under the Privacy Act 1993 or the Official Information Act 1982 to access this information and request that it be corrected.
Surrender details
Surrender:
Partial surrender:
If partial surrender, area to be surrendered: (hectares/square kilometres)
Person to contact concerning this application
Full name of contact person:
Email address:
Contact telephone:
Supporting information
Please send with your notice the prescribed fee required under the Crown Minerals (Minerals Fees) Regulations 2006 for a notice of this type (or evidence of it having been paid) and any information that is required under the Crown Minerals (Minerals and Coal) Regulations 2007 to accompany a notice of this type.
Authorised signature*
Authorised signature(s):
Print name:
Position of signatory:
Date:
*If made by 2 or more persons, this application must be signed in accordance with regulation 6 of the Crown Minerals (Minerals and Coal) Regulations 2007.
Form 3 |

Permit holder details*
Full name of permit holder:
Permit number:
Address for service:
*The personal information you must include in this form is needed to process your application under the Crown Minerals Act 1991. You have the right under the Privacy Act 1993 or the Official Information Act 1982 to access this information and request that it be corrected.
Person to contact concerning this notice
Full name of contact person:
Email address:
Contact telephone:
Supporting information
Please send with your application the prescribed fee required under the Crown Minerals (Minerals Fees) Regulations 2006 for an application of this type (or evidence of it having been paid) and any information required under the Crown Minerals (Minerals and Coal) Regulations 2007 to accompany an application of this type.
Authorised Signature*
Authorised signature(s):
Print name:
Position of signatory:
Date:
*If made by 2 or more persons, this application must be signed in accordance with regulation 6 of the Crown Minerals (Minerals and Coal) Regulations 2007. However, under regulation 28(4) of those regulations, an exception applies if the application is for the Minister's consent to otherwise deal with a permit (in which case only the permit holder to whom the dealing directly relates is required to sign the application).
Form 4 |
I, [full name of permit holder/permit applicant] of [address for service], being the holder of permit [permit number],* give notice under section 83 of the Crown Minerals Act 1991 of an access arrangement (within the meaning of section 2(1) of that Act) with the following:
| *Include permit number if permit holder; delete phrase if permit applicant. |
Land owner and occupier: [full name of land owner and occupier with whom arrangement entered into]*
| *If the land owner and occupier are the same person, specify here; if the land occupier and owner are different, specify below. |
Land owner: [full name of land owner with whom arrangement entered into]
And
Land occupier: [full name of land occupier with whom arrangement entered into]
Description of land: [specify cadastral descriptions and certificate of title or other instrument of land title details to which the access arrangement relates]
Date access arrangement commenced:
Duration of access arrangement:
Permit duration (if arrangement relates to a permit already granted):
I/We being the permit holder(s)/applicant(s)* or the person authorised to sign on behalf of the permit holder(s)/applicant(s)* declare that the information given in this notice is true and correct.
| *Delete whichever does not apply. |
(permit holder/permit applicant/person authorised to sign)
Dated:
(permit holder/permit applicant/person authorised to sign)
Dated:
A copy of the access arrangement that has been made with the land owner and any occupier is attached to this notice.
Under section 83(1) of the Crown Minerals Act 1991 you are required to lodge 3 copies of this notice with the Registrar-General of Land, accompanied by any fee prescribed by regulations made under the Land Transfer Act 1952.
Form 5 |
I, [full name of the applicant], of [address for service], being the holder of coal mining right [reference number], give notice of appeal under section 109(3) of the Crown Minerals Act 1991 against the decision of [name of the Regional Council that made the decision to increase the bond or deposit that applies to the coal mining right held].
Date of the decision appealed against:
Date on which notice of the decision was received by the appellant:
Amount of the deposit or bond originally lodged under section 71(1) of the Coal Mines Act 1979:
Level of the deposit or bond since the Regional Council’s decision under section 109(2) of the Crown Minerals Act 1991:
Grounds on which the appeal is based:
The relief the appellant seeks:
Full name:
Telephone:
Fax:
Postal address (if different from address above):
I/We the holder(s) of the coal mining right/the person(s) authorised to sign on behalf of the holder(s) of the coal mining right* declare that the information given in this notice is true and correct.
| *Delete whichever is inapplicable. |
(Signature of coal mining right holder(s)/person(s) authorised to sign)
Dated:
(Signature of coal mining right holder(s)/person(s) authorised to sign)
Dated:
Attach the following documents to this application (please print your name on each page):
a copy of the decision or relevant part of the decision of the Regional Council:
any other documents necessary for an adequate understanding of the appeal.
“see attached sheet”in the appropriate space, and attach the sheet to the notice.
Serve a copy of the notice on the Regional Council and on the Chief Executive of the Ministry of Economic Development either before or immediately after it is lodged with the Environment Court.
Lodge your notice of appeal with the Environment Court.