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Land nomination form – Coastal Lands Protection Scheme
Current
Part A - Contact details
Part B - Site details
Part C - Acquisition criteria
Part D - Supporting documents and signature
Complete
Please use this form if you wish to nominate land for public acquisition under the Coastal Lands Protection Scheme, which the Department of Planning, Industry and Environment administers.
If you wish to authorise another person to act as an agent (representative) on your behalf, please discuss with them first and seek their consent.
You will need to download and complete the
Agent’s authority to act form
which both you and the agent must sign.
The Agent’s authority to act form can be attached at Part D of this application.
Contact details
First and last name
Company or trust name (if applicable)
Postal address
Email
Phone number
Phone number
Mobile number
Mobile number
Preferred contact
- None -
Mobile
Home
Email
Are you the landowner?
Yes
Please proceed to Part B.
No
Are you acting on behalf of the landowner?
Yes
Please proceed to Part B. You must also download and submit the Agent’s authority to act form, which both you and the landowner must sign. Attach the form at Part D.
No
If you are not the landowner or the landowner’s representative, have you sought the landowner’s consent to nominate the land for acquisition?
Yes
Please provide details below.
No
Note: this is unnecessary if the land is for sale; in this case, proceed to Part B.
What is the landowner’s position on selling the land to the department?
Landowner contact details
You
must
seek the landowner’s consent to provide these details.
First and last name
Company or trust name (if applicable)
Postal address
Email
Contact number
