C3 If you want more than one holding to exit from the original access licence, specify the number of new water access licences you would like granted to replace the exited holdings: (tick the appropriate box) One new water access licence to replace all exited holdings One new water access licence to replace each exited holding Other combination – provide details below using the holding identifiers created for each holding: Note: One holding cannot be replaced by more than one new water access licence. SECTION D: Applicants Provide the name of each applicant in this section. The applicants are the co-holder/s of the holdings to exit from the original access licence which are listed in C2. If you want more than two holdings to exit from the original access licence, attach extra copies of this page. If there are more than two co-holders of a holding, attach extra copies of this page. D1 Holding identifier: (if applicable) D2 Number of co-holders of this holding: 1 2 Other (specify): Name of co-holder 1 D3 Title (Mr, Mrs, Ms) D4 Surname D5 Given name/s D6 Company/corporation name (if applicable) Name of co-holder 2 D7 Title (Mr, Mrs, Ms) D8 Surname D9 Given name/s D10 Company/corporation name (if applicable) D11 Holding identifier: (if applicable) D12 Number of co-holders of this holding: 1 2 Other (specify): Name of co-holder 1 D13 Title (Mr, Mrs, Ms) D14 Surname D15 Given name/s D16 Company/corporation name (if applicable) Name of co-holder 2 D17 Title (Mr, Mrs, Ms) D18 Surname D19 Given name/s D20 Company/corporation name (if applicable) D21 Have extra copies of this page been attached? No Yes - specify number: SECTION E: Consent provided for this application
H13 I am an applicant (I want to exit my holding from the original access licence). H14 I am not an applicant (I am providing consent to this application). Signature Date H15 Title (Mr, Mrs, Ms) H16 Surname H17 Given name/s H18 Address H19 Town H20 State H21 Postcode H22 Country H23 Phone H24 Mobile phone H25 Fax H26 Email I am the holder of a holding in the original access licence and: (tick the appropriate box) H27 I am an applicant (I want to exit my holding from the original access licence). H28 I am not an applicant (I am providing consent to this application). Signature Date If there are more than two individuals signing Section H, attach extra copies of this page. H29 Have extra copies of this page been attached? No Yes - specify number: For applications made by a corporation: Executed for and on behalf of the applicant in accordance with section 127 of the Corporations Act 2001 Cth (if a company) or by its duly authorised officer (for other types of corporations). H30 Company/corporation name H31 ACN or ABN H32 Address H33 Town H34 State H35 Postcode H36 Country H37 Phone H38 Mobile phone H39 Fax H40 Email This company/corporation is the holder of a holding in the original access licence and: (tick the appropriate box) H41 is an applicant (the company/corporation’s holding is to be exited from the original access licence). H42 is not an applicant (the company/corporation provides consent to this application). H43 Position of signatory company director company secretary duly authorised officer