APPLICATION TO LEASE/LICENCE ARTC LAND

Transcription

1 IIN EE/IENE R ND his form is to be used by any person/s or entity who wishes to lease or licence land/improvements within the Railway orridor for any reason. lease provide as much detail, in as many sections of this form as possible regarding your proposal. Incomplete data may impede the processing of your application. Where there is insufficient space in these boxes to provide all the information requested, the pplicant should attach additional papers or documents to this pplication form. 1. pplicant Details lease describe the role of the individual/organisation making this pplication, please tick the appropriate boxes: (Details of the Individual/ompany making the application) Individual Name: ompany Name: I N BN / N: Registered ddress: uburb: Box / ocked Bag: uburb: ontact erson: tate & ost ode: tate & ost ode: hone: Fax: Mobile: ddress: Ref # HRIM 65/000/0 age 1 of 5

2 2. ocation (Describe fully the geographic location; please provide a map or a sketch to assist in describing the location) treet ddress: I N Nearest Rail ocation: (suburb) Rail Kilometrage: from; (nearest ydney) ine Detail: itle Details: Description of the roperty: to; rea: (m²) 3. Development pplication from ocal ouncil lease indicate stage reached D G E Not yet submitted to ouncil urrently being considered by ouncil Issued by ouncil (please attach a copy with application) Not applicable 4. roposal R Describe fully the proposal; urpose: erm: roposed ommencement Date: Ref # HRIM 00/000/0 age 2 of 5

3 5. History Have you or your ompany previously ease or icence railway land? No Yes (please specify) 6. Fee Refer to pplication etter (non-refundable) heque attached Remittance advice attached ccount Name: Bank: BB: ccount Number: ustralian Rail rack orporation td National ustralia Bank 22 King William treet DEIDE 5000 Fax No. for Remittance: (08) for Remittance: 7. Insurance, Identification and Business cumen D opy of ertificate of urrency for ublic iability Insurance ($20M) opy of Business cumen, i.e. References wo forms of Identification ther 8. utgoings he tenant is responsible for rates and taxes, outgoings, all costs associated with the lease agreement being registered including survey plans, stamp duty, administration and legal fees. 9. Rent Rental will be determined once it is ascertained how much area is to be leased plus G if applicable. Ref # HRIM 00/000/0 age 3 of 5

4 10. ketch detailed site plan of the proposed lease area is required providing information as requested below, however to gain this information you MU N ENER UN RI ND R IN HE RI RRIDR. ll information is to be gathered from outside railway land: 1. ommencing Kilometer 2. Dimensions of the area sought in meters both length and width 3. ower or telephone lines / any buildings 4. How will access to the lease area be gained 5. Indicate name of any adjoining treet/roadway/roperty wner Ref # HRIM 00/000/0 age 4 of 5

5 11. uthority Name of applicant: Date: ignature of applicant: igned for and on behalf of: lease return the completed application and any attachments to one of the following: ttention: Nicole pear roperty fficer North oast (02) Unit 5, 33 Newton treet Broadmeadow NW 2292 ocked Bag 1, Broadmeadow NW 2292 (02) ttention: Monica ampaklis roperty fficer Hunter Valley (02) Unit 5, 33 Newton treet Broadmeadow NW 2292 ocked Bag 1, Broadmeadow NW 2292 (02) ttention: Josephine Beckmans roperty fficer North outh (02) tation lace Wagga Wagga NW 2650 Box 2150, Wagga Wagga NW 2650 (02) ttention: Ruth Warren roperty fficer East West (08) ir Donald Bradman Drive Keswick erminal 5035 Box 10343, Gouger treet, delaide 5000 (08) ttention: Derek Rogers roperty Manager Metro Freight Network ydney (02) evel 15, 60 arrington treet ydney NW 2001 G Box 14, ydney NW 2001 (02) Ref # HRIM 00/000/0 age 5 of 5