Change Of Address Of A Permit Holder
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2Mines ABN 59 020 847 551
Change of address of a permit holder
Section 388 Mineral Resources Act 1989, section 852 Petroleum and Gas (Production and Safety) Act 2004,
section 129 Petroleum Act 1923, section 376 Geothermal Energy Act 2010 and
section 421 Greenhouse Gas Storage Act 2009
Form MMOL-02 Version 3
Instructions
Part A: Permit details - Use this section to detail what permit details you want the changes to apply to.
Part B: Address and contact details - In this section, you can update an authorised permit holder’s address or other holders
address.
Please use a pen, and write neatly using BLOCK LETTERS. Cross where applicable
You may complete the original of this application and submit the application with any attachments at a
Mines Lodgement
Office.
NOTE: To nominate an authorised holder representative (AHR = an individual who has the authority to liaise with the department
on behalf of the holders) or to update the details of a current AHR please refer to Form MMOL-2A. More information on AHR’s
can be found in the guide.
Part A – Permit details
1
Permit type
Tick
Number(s)
Mineral Resources Act 1989:
Exploration permit mineral
o
Exploration permit specified minerals
o
Exploration permit coal
o
Mineral development licence
o
Mining claim
o
Mining lease
o
Petroleum and Gas (Production and Safety) Act
2004 and Petroleum Act 1923:
Authority to prospect
o
Petroleum lease
o
Petroleum survey licence
o
Petroleum pipeline licence
o
Petroleum facility licence
o
Geothermal Energy Act 2010:
Exploration permit geothermal
o
Geothermal lease
o
Greenhouse Gas Storage Act 2009:
Exploration permit greenhouse gas
o
Greenhouse gas injection and storage lease
o
Application entered onto
OFFICE USE ONLY
Receiving officer
MyMinesOnline
Y
N
I confirm that:
Received at: ________________
•
the details on application form have been
Name: ___________________________
checked;
•
all attachments have been submitted;
Signed:___________________________
Received by: ________________
•
correct application fees have been submitted.
Date:
/
/
Name: ___________________________
Date:
/
/
Signed:_________________________ Date:
/
/
Time:
AM/PM
Page 1 of 2
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