Go to top of page Error message Warning: array_pop() expects parameter 1 to be array, boolean given in govcms_uikit_captovate_preprocess_node() (line 142 of /home/otl/htdocs/www.otl.gov.au/sites/all/themes/govcms_uikit_captovate/template.php). 1 Start 2 2. LOCATION 3 3. PROPOSED USE 4 4. TIMEFRAMES 5 5. THIRD PARTIES 6 6. National police records check 7 8. Authority certificate 8 9. Agreement 9 Complete Business name or nominee ABN/ACN/ICN Is your organisation A sole trader or partnership? A company? Please list details of all partnersPERSON 1 Full name DOB Business address Mailing address if different to address given above PERSON 2 Full name DOB Business address Mailing address if different to address given above PERSON 3 Full name DOB Business address Mailing address if different to address given above PERSON 4 Full name DOB Business address Mailing address if different to address given above Contact person Full name Position Phone Email Please list details of the Chief Executive (or equivalent) as well as at least two Directors PERSON 1 – CEO or EQUIVALENT Full name DOB Business address Mailing address if different to address given above Have you completed and submitted consent to allow a national police record check to determine whether a person had been convicted of a crime against children? Yes No PERSON 2 – DIRECTOR Full name DOB Business address Mailing address if different to address given above Have you completed and submitted consent to allow a national police record check to determine whether a person had been convicted of a crime against children? Yes No PERSON 3 – DIRECTOR Full name DOB Business address Mailing address if different to address given above Have you completed and submitted consent to allow a national police record check to determine whether a person had been convicted of a crime against children? Yes No PERSON 4 Full name DOB Business address Mailing address if different to address given above Have you completed and submitted consent to allow a national police record check to determine whether a person had been convicted of a crime against children? Yes No PERSON 5 Full name DOB Business address Mailing address if different to address given above Have you completed and submitted consent to allow a national police record check to determine whether a person had been convicted of a crime against children? Yes No Are you of Aboriginal or Torres Strait Islander descent?* Yes No Prefer not to answer Do you/your organisation currently occupy land or hold a sublease in the community? Yes – sublessee Yes – occupy land No Do you/your organisation deliver services or programmes, or conduct business in the community? Yes No Please provide details Please briefly describe Leave this field blank (optional)