1.3 Have you ever had a licence to cultivate low-THC hemp (or equivalent) refused, suspended or cancelled anywhere in Australia? Yes No 1.4 If you answered “Yes” to the previous question please provide details of this refusal, suspension or cancellation Declaration by Close Associate B I declare that I am a close associate of the applicant and that the information provided in relation to myself, to the best of my knowledge, is true and correct in every particular. Name Signature Date Part 3 – Activity For what purpose is this licence required? Note: Please read the Guidelines for definitions of these activities Cultivate low-THC hemp for: Note: a licence can authorise both “cultivate” and “supply” Commercial production ► Complete section 3.1 Manufacturing process ► Complete section 3.2 Scientific purposes – Research, instruction, analysis or study ► Complete section 3.3 Note: a licence can authorise more than one activity Supply low-THC hemp for: Note: “Supply” includes - sell and distribute. If you cultivate low-THC hemp, you may also want to sell it Commercial production ► Complete section 3.4 Manufacturing process ► Complete section 3.5 Scientific purposes – Research, instruction, analysis or study ► Complete section 3.6 What is the nature of the activities that you propose to carry out? Cultivate low-THC hemp to produce: Fibre Seed Other …………………………………………………………………….. Supply: Fibre Seed Other ……………………………………………………………………..
Hemp products Please describe all the hemp material or products you (the applicant) intend to produce as part of your business Note: The Hemp Industry Act 2008 cannot authorize licences for the cultivation and supply of low-THC hemp for medicinal or therapeutic purposes. Destination of hemp Please state the intended destination of the low-THC hemp material (if known) Note: If the destination of the low-THC hemp is not known, you will need to provide details of the final destination of your crop in your annual report. Licence duration request Maximum 5 years 1 2 3 4 5 (years) 3.1 Cultivate – for commercial production Complete this section if you intend to cultivate low—THC hemp for commercial production Please check the Guidelines for the definition of this activity Property details – location where the low-THC hemp will be cultivated Property name Address Locality Postcode Lot Number DP No. PIC Property Identification Code N a. Do you (the applicant) own this property? Yes ► go to question c. No ► please complete question b. b. Name of owner Address of owner State Postcode Note: You must also submit a signed consent form from the property owner with your application
b. Do you know the details of the researcher to whom you will be supplying the low-THC hemp to? Yes ► please answer question c. No ► you will need to provide this information in your annual report c. Name of person to whom you will be supplying low-THC hemp Business Name Address address Telephone Mobile d. Will you be supplying low-THC hemp that was not cultivated by you? Yes ► provide details of the cultivator at e. No ► go to question f. e. Name of cultivator Address State Postcode Licence number f. What research, analysis, instruction or study will the hemp be used for, if known? g. Provide an estimate of the quantity of low-THC hemp to be supplied for commercial production annually Part 4 – Paying fees If paying by cheque, please make payable to: NSW Department of Primary Industries – Hemp Licensing If paying by credit card please provide the following details Name As it appears on the card Type of card Visa MasterCard American Express Diners Club