Category Explanation Report and Map Reviewapplication Form

Category Explanation Report and Map Reviewapplication form

Use this application form for a Native Vegetation Regulatory Map Category Explanation Report (CER) or Map Review.

Fact sheets and frequently asked questions about CERs and Map Reviews can be found at here.

It is recommended that you obtain a CER for your landholding before applying for a Map Review.

Section A – Application type

I wish to apply for a:

☐CER– complete all sections of the form except for Section E, or

☐Map Review–complete all Sections of the form.

Section B –Landholdercontact details

Note: Providing false or misleading information may be an offence. If you are applying on behalf of a company, corporation, partnership, trust or other business entity, please add the name, contact details and ID for the nominated representative acting on behalf of the business.

Surname: Click or tap to enter surname

Mr/Mrs/Ms/Other:Choose an item.

First name(s): Click or tap to enter first name Date of birth: Enter birthdate here

Name of company/corporation/partnership/trust if applicable: Enter full company name here

ABN:Enter number

Postal address: Address Line 1

Postcode:Enter postcode here

Email address:enter email address here

Phone number – Work:Work numberHome:Home number

Mobile Mobile number Preferred Contact: Choose from list

Are you using an agent to act on your behalf during this process?Yes ☐ No ☐

If yes,complete the Agent’s Authority to Act formon Page 5 and provide a completed application form to your agent.

Section C – Landholder Proof of Identification

Number: License Number Expiry date: Enter expiry date here

(If you do not have a Drivers’ License please contact the map review team on 6363 8700 or )

Section D– Landholdinginformation

Please state if you are the owner, lessee or other:Choose from list Other: Enter description of your direct association with the land

Note: You must provide evidence to verify your legitimate and direct association with the landholding. Provide a description of your direct association with the land below and attach supporting documents. (e.g. rates notice, title deed, lease agreement).

List all Lot and Deposited Plan (DP) numbers applicable to the land to be assessed in this application: Attach a separate list ifrequired.

Lot number / Section / DP number / Lot number / Section / DP number
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and/or

I have attacheda copy of a map clearly identifying the boundary of the area/s to be covered by the CER or Map Review application. Yes ☐ No ☐

Note:If the application covers only part of a lot or lots, only these areas need to be identified. If the application covers the whole of the landholding, only the property boundary needs to be identified.

Section E – Information supporting your Map Review application

(for a Map Review application only)

Why do you believe the categorisation of the identified land on the NVR Map is incorrect? Give your reasons in the table (the first two rows are examples). You must attach copies of any relevant information, including documents, photos or other images.Attach a separate list if required.

Map ref / Reason for categorisation map review
(What event/s occurred? When did event/s occur?) / Supporting evidence:
Section A / Land was cleared in 1989 for cropping / See attached map & photos
Section B / Land is covered by a Voluntary Conservation Agreement / Copy of agreement & map attached
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Section F– Signature(Section F must be completed for all applications)

It is an offence to provide information in connection with a matter under Part 5A Local Land Services Act 2013 that you know, or ought reasonably to know, is false and misleading in a material particular (see s13.10 Biodiversity Conservation Act 2016).

I, full name of applicant,state that the information provided as part of this application is trueand correct to the best of my knowledge.

Signature of applicant ______Date: Enter date here

Section G – If using an agent

Please ensure the Agent’s Authority to Act form (page 5 below)is completed and submitted with the application if you are using an agent.

Agents name: Enter agents name here

Information provided in this application form is collected for the purposes of providing OEH CERs,carrying out Map Reviews and administering the Native Vegetation Regulatory Map generally. The information may be shared with other government agencies if directly relevant to the administration of Part 5A LLS Act or the LLS Regulation.The supply of information is voluntary, but is necessary for the purposes of obtaining a CER or Map Review. To access or update your information, or for more details on our privacy obligations, please contact an OEH Senior Governance Officer on (02) 9995 6080 or visit .

Checklist for submitting your application

☐Complete all fields in this form.

☐Complete the attached Agent’s Authority to Act, if you are using a third party to manage your application – see below.

☐Attach copies of any information relevant to determining whether the land meets the requirements for categorisation. (Such material may include land agreements, farm management records, photographs etc.)

☐Attach a copy of a map clearly identifying the boundary of the area/s applicable to this application. This is important when the area of interest includes only part of a lot or lots. You may also include a map for a whole lot/s or your whole property if desired. For online applications, the OEH online mapping tool can be used to identify the land to be reviewed.

☐Submit your application:

• by scanning and emailing this application to
• by completing online using the OEH Case Management System
• in person at selected Local Land Services and OEH Offices, or
• by mail to:

NSW Office of Environment & Heritage

LIMR Team

Locked Bag 6010 -

Orange NSW 2800

Category Explanation Report & Landholder Initiated Map Review Application

AGENT’S AUTHORITY TO ACT

Agent to complete:

Agent name: Enter name here Number: License Number Expiry date: Enter date here

Agent Company Name (if applicable)Company Name.

Agent address: Enter address here text.

Email address:enter email address here

Phone number – Work: Work number Mobile:Mobile number Preferred Contact: Choose from list

Driver’s License Number: License Number Expiry date: Enter expiry date here

Signature of agent: ______Date: Enter date here

Landholder to complete:

I authorise the person whose name and signature appears above to act on my behalf to complete all relevant application forms and to do any of the following things on my behalf in relation to an application for a Category Explanation Report and/or Landholder Initiated Map Review:

☐Communicate with and provide anyrequired information to the OEH to determinemy Map Review

☐Receive any communications from OEH

☐Receive the Category Explanation Report

☐Receive the notification of the outcome of my request for a Map Review

Landholder name(as shown on the attached application form): Landholder name

Signature of applicant ______Date: Enter date here

☐I wish to receive a copy of a Category Explanation Report or Map Review Determination only

☐I do not wish to receive any information from OEH, please send all communications direct to my agent

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