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Change Application Form - Department Of Infrastructure, Local Government And Planning Page 4

Privacy – Personal information collected in this form will be used by the responsible entity and/or chosen assessment

manager, any relevant affected entity or referral agency and/or building certifier (including any professional advisers which

may be engaged by those entities) while processing, assessing and deciding the change application.

All information relating to this change application may be available for inspection and purchase, and/or published on the

assessment manager’s and/or referral agency’s website.

Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017 and

the DA Rules except where:



such disclosure is in accordance with the provisions about public access to documents contained in the Planning Act

2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning

Regulation 2017; or



required by other legislation (including the Right to Information Act 2009); or



otherwise required by law.

This information may be stored in relevant databases. The information collected will be retained as required by the Public

Records Act 2002.

PART 7 – FOR OFFICE USE ONLY

Date received:

Reference number(s):

QLeave notification and payment

Note: For completion by assessment manager if applicable

Description of the work

QLeave project number

Amount paid ($)

Date paid

Date receipted form sighted by assessment manager

Name of officer who sighted the form

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of

Infrastructure, Local Government and Planning. This form and all other required change application materials should be

sent to the responsible entity.

Page 4

Planning Act Form 5 - Change application form

Version 1.0—3 July 2017

Change Application Form - Department Of Infrastructure, Local Government And Planning Page 4