INVOICING DETAILS //
Invoices will be made out to the applicant but can be sent to another party if paying on the applicant’s behalf.
For more information regarding payment please refer to the Fees Information section of this form.
*Attention:
*Postal Address: *Post code:
*Email:
Applicant: Agent: Other, please specify:
Email: Post:
Please select a preference for who should receive any invoices and how they would like to receive them.
Please provide an email AND full postal address.
APPLICANT // Must be a person or legal entity (limited liability company or trust). Full names of all trustees required.
CORRESPONDENCE DETAILS // If dierent than above – E.g. consultant, agent or architect
Name & Company:
Phone Numbers: Day Mobile:
Email Address:
Our preferred methods of corresponding with you are by email and phone.
The decision will be sent to the Correspondence Details by email unless requested otherwise.
RESOURCE CONSENT BEING SURRENDERED
*Provide RM number of Resource Consent to be surrendered: RM
*Applicant’s Full Name / Company / Trust:
(Name of consent holder)
*All trustee names (if applicable):
Contact Name if company or trust:
*Postal Address: *Post code:
*Email Address:
*Phone Numbers: Day Mobile:
PLEASE COMPLETE ALL MANDATORY FIELDS* OF THIS FORM.
Page 1/7 // 13 July 2018
APPLICATION FOR RESOURCE CONSENT
SURRENDER OF CONSENT
APPLICATION
Under Section 138 of the Resource Management Act 1991
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: resourceconsent@qldc.govt.nz
www.qldc.govt.nz
Please note processing will not begin until payment is received (or identied if incorrectly referenced).
I conrm payment by: Bank transfer to account 02 0948 0002000 000 (If paying from overseas swiftcode is – BKNZNZ22)
Use the reference RM and the rst 5 letters of applicant name (e.g RMJONES)- if paying prior to submitting application
Use the RM# reference provided by Planning Support (e.g RM170123) - if paying after submitting application
Cheque payable to Queenstown Lakes District Council attached
Manual Payment at reception (can only be accepted once application has been lodged and
acknowledgement email received with your unique RM reference number)
*Reference
*Amount Paid
(For required initial fees refer to website for Resource Consent Charges or speak to the Duty Planner by phoning 03 441 0499)
*Date of Payment
PAYMENT // An initial fee of $195 payable upon submitting this application.
APPLICATION & DECLARATION
The Council relies on the information contained in this application being complete and accurate. The Applicant must take all reasonable
steps to ensure that it is complete and accurate and accepts responsibility for information in this application being so.
If lodging this application as the Applicant:
I/we hereby represent and warrant that I am/we are aware of all of my/our obligations
arising under this application including, in particular but without limitation, my/our
obligation to pay all fees and administrative charges (including debt recovery and legal
expenses) payable under this application.
If lodging this application as agent of the Applicant:
I/we hereby represent and warrant that I am/we are authorised to act as agent of the Applicant in
respect of the completion and lodging of this application and that the Applicant is aware of all of
his/her/its obligations arising under this application including, in particular but without limitation,
his/her/its obligation to pay all fees and administrative charges (including debt recovery and legal
expenses) payable under this application.
I hereby apply for the resource consent(s) for the Proposal described above and I certify that, to the best of my
knowledge and belief, the information given in this application is complete and accurate.
*Signed (by or as authorised agent of the Applicant) **
*Full name of person lodging this form
Firm/Company *Dated
**If this form is being completed on-line you will not be able, or required, to sign this form and the on-line lodgement will be treated as
conrmation of your acknowledgement and acceptance of the above responsibilities and liabilities and that you have made the above
representations, warranties and certication.
OR:
PLEASE TICK
DETAILS OF SITE
*Address / Location to which this application relates:
*Legal Description:
Can be found on the Computer Freehold Register or Rates Notice – e.g Lot x DPxxx (or valuation number)
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: resourceconsent@qldc.govt.nz
www.qldc.govt.nz
Page 2/7 // 13 July 2018
Please select
click to sign
signature
click to edit
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