Application For A Commercial Producer'S Licence

Application for a Commercial Producer’s Licence-Timber

Proforma letter (for private property owner/occupier) to authorise other persons to harvest and sell

protected flora from land stated below, and apply for a licence issued under the Wildlife Conservation

Act 1950 to do so.

Land owner/occupier details:

…………………………..……..

Name of the land owner/occupier

: …………

(delete whichever does not apply)

…………………………………………...

Postal address of the land owner/occupier

……………………………………………

: ………………………………………………..…

Contact telephone number for the land owner/occupier

Land permission details:

Please be advised that as the owner/occupier

of the property:

(delete whichever does not apply)

Property name:

………………………………………….………..

Lot/Location No(s) or Street Address:

…………………………………………….……..

Local Government Authority:

………………………………….……….……….

…………………………………………….. (

) of

I give permission for

print name of applicant

……………………………………………………….……………..

)

to harvest and sell the

(print address

following species of protected flora from my property as listed above.

Flora species to which this authorisation applies:

Either tick the ‘All species’ box, list the species in the

space provided, or tick the ‘List attached’ box and attach and sign a list:



……………………….……………

All species

List attached

…………………………….……….

Period for which this authorisation applies:

Either tick the ’12 months from date of issue’ box, or state a

time period (

Note: Permissions can only be granted for a maximum of 12 months):



12 months from date of issue

…..…/……/20….. to ………/……/20.….

Special conditions that apply to this authorisation

(e.g. area, methods, use of facilities):

………………………………………………………………….……………………………………………………

.…………………………….………...……………………………………………………………………….

Signed .......................................…………………

This proforma may be photocopied to allow for

attaching multiple permissions for multiple private

Name(Print): …………………………….…………

properties.

Date

............../............./20.............

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