Application form
Biodiscovery
Collection authority (biodiscovery)
This form is to be used to apply to the Department of Environment and Heritage Protection (EHP) for a Collection authority
for biodiscovery purposes, as defined in the Biodiscovery Act 2004 (the Act).
Important information for applicants
Before completing the application form, please ensure you read the essential support documents, including the
Guideline: Completing an application form for a Collection authority (biodiscovery), and the Compliance code for
taking native biological material under a Collection authority, available via the EHP website. It is also advisable
to read the Biodiscovery Act available for the Office of the Queensland Parliamentary Counsel website
https://www.legislation.qld.gov.au. If you need to discuss details of your application or have queries, please
contact the Permit and Licence Management on 1300 130 372 to be transferred to the relevant permit
processing officer.
Collection of native biological resources authorised under a Collection authority cannot start until a benefit
sharing agreement (BSA) has been negotiated with the State through the Queensland Department of Science,
Information Technology, Innovation and the Arts (DSITIA) and access has been negotiated with the land/water
manager.
The applicant is required to submit either a draft or an approved biodiscovery plan, which can be obtained from
the DSITIA website http://www.business.qld.gov.au to EHP with this application.
Access to State lands or Queensland waters may be affected by issues of ecology, safety or legal jurisdiction;
you are advised to obtain access approval at the earliest possible opportunity. Applicants wanting to collect from
Queensland waters that are subject to Federal Government jurisdiction must negotiate with the relevant
authority before proceeding. For example, the Great Barrier Reef Marine Park Authority (GBRMPA), the Wet
Tropics Management Authority , the Department of National Parks, Sport, Recreation and Racing or the
Commonwealth Department of Foreign Affairs and Trade.
This Collection authority cannot be transferred. No fees apply to this authority type. Please allow a minimum of
40 business days for your application to be processed.
For questions requiring more space for your answer, copy relevant tables, or note the question being responded
to at the top of any additional pages required, and attach such pages to this form. Indicate on the appropriate
page/s of this form that there is attached information.
Part A – Applicant information
An authority may only be granted to an individual acting independently of a corporation or partnership, or to a
corporation. Please tick the appropriate box:
I am applying as an individual - Complete question 1 then proceeding to question 3.
I am applying on behalf of a corporation – Proceed to questions 2.
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ABN 46 640 294 485
Application form
Collection authority (biodiscovery)
Applicant details for an individual
APPLICANT’S FAMILY NAME
TITLE
APPLICANT’S GIVEN NAME
DATE OF BIRTH
RESIDENTIAL ADDRESS
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
FACSIMILE
POSTAL ADRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL ADDRESS)
POSTCODE
(i) Application details for corporations
REGISTERED LEGAL ENTITIY NAME
TRADING NAME/S (IF DIFFERENT)
REGISTERED BUSINESS ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
EMAIL
FACSIMILE
WEBSITE
POSTAL ADRESS (WRITE “AS ABOVE” IF SAME AS BUSINESS ADDRESS)
POSTCODE
ABN / ACN / AN, OR TITLE AND SECTION OF LEGISLATION UNDER WHICH CORPORATION HAS LEGAL STATUS
SIGNATURE OF PRINCIPAL OF CORPORATION (or person authorised to sign of their behalf)
DATE
(ii)Corporation’s nominated person in charge of the project
FAMILY NAME OF NOMINATED CONTACT PERSON
GIVEN NAMES OF NOMINATED CONTACT PERSON
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TITLE
DATE OF BIRTH
Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (BUSINESS HOURS)
EMAIL
FACSIMILE
POSTAL ADRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL ADDRESS)
POSTCODE
Part B – Project and methodology
What is the name of the project you wish to collect for?
PROJECT NAME:
Do you have an approved or drafted Biodiscovery Plan, negotiated with DSDTI for the
project this application relates to?
Yes
Please attach your draft or approved biodiscovery plan. You will have 12 months from the date your Collection
authority is approval to finalise your Benefit Sharing Agreement with the State. You may not collect until this is
approved.
No
If no, your application cannot be processed. Please develop a Biodiscovery Plan with DSITIA before submitting this
application.
Do you hold, or have you held a Collection authority (biodiscovery) for any of the
native biological resources you propose to collect in this application?
Yes
If yes, please state the authority number(s), and the issue and expiry dates.
No
AUTHORITY NUMBER/S
EXPIRY DATE/S
Will your proposed collection take place within Queensland waters?
Note: Queensland waters include inland waters, both fresh and saline, and coastal and marine waters.
Yes
If yes, please indicate the collection location/s
No
LOCATION OF COLLECTION – GPS OR LAT/LONG CO-ORDINATES (ATTATCH ADDITIONAL SHEETS IF NECESSARY, AND INDICATE ATTATCHMENT BELOW)
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Issue and expiry of the Collection authority (biodiscovery)
(i) Do you want the authority to be active when issued?
Yes
No
If no, what date would you like the authority to become active?
PREFERRED START DATE
(ii) Do you want the authority for the maximum period of three years?
Yes
No
If no, what date would you like the authority to expire?
PREFERRED EXPIRY DATE
Will your collection of native biological material under this Collection authority be
consistent with all aspects of the code?
Note: Collection that is entirely consistent with the code can be issued with a standard Collection authority.
Where proposed collections are inconsistent with the Code, applications receive further assessment to
determine their compliance with the Act and the need for additional conditions .
Yes
Collection will be entirely consistent with the Compliance code — complete Attachment 1 below and for
examples refer to Question 9 .of the Guideline - Completing an application form for a Collection authority
(Biodiscovery).
No
Collection will be inconsistent with the Compliance code entirely — complete Attachment 2(i), (ii) and
(iii) below and for examples refer to Question 10.of the Guideline - Completing an application form for a Collection
authority (Biodiscovery).
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Attachment 1: Collection consistent with the Code
Table (i)
Details of taxa proposed for collection (refer to Question 9 and Attachment 1 of the Guideline - Completing an application form for a Collection authority (Biodiscovery)).
Applicants must complete a new line for each combination of: sample x taxon. Where micro-organisms are to be collected, include details of the collection
environment or host. Note: Please remember to attach copies of this table if there is insufficient room below.
Item
Scientific name of taxon to
be collected and where
applicable, the collecting
environment (ie soil and
water for micro-organisms),
or the host taxon. State the
lowest taxonomic level known.
Common name (where known)
Conservation
status under the
Nature
Conservation Act
1992
EW = extinct in the
wild
E = endangered
R = rare
V = vulnerable
NT = near threatened
C = common
NL = not listed in NCA
Nature of sample to be collected
Method of capture/collection
Non-lethal collection:
AF = fluid (animal)
AT = tissue (animal)
PB = bark
PG = gums/resin/exudate/sap
PR = roots/rhizomes
PL = l eaves/flowers
PF = fruit/spores/seeds
Lethal collection:
M = micro-organism
I=
whole aquatic invertebrate
T = whole terrestrial invertebrate
F = whole fish
P = whole plant/algae
MF = whole macrofungi
O = other, please specify
Fish and invertebrates:
NR = net and return
NE = net and euthanase
TR = trap and return
TE = trap and euthanase
CR = catch/collect and return
CE = catch/collect and/or euthanase
Invertebrates and micro-organisms:
S = soil sample
W = water sample
H = host organism
Plants, macro-algae, fungi:
HP = harvest parts
HW = harvest whole
O = other, please specify
Insert extra lines as required.
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Appendix 2: Collection inconsistent with the Code
Table (i)
Details of taxa proposed for collection that are effected by inconsistency with the Code (for examples refer to Question 10 and Attachment 2 of the
Guideline - Completing an application form for a Collection authority (Biodiscovery)).
Complete a new line for each combination of: taxon x sample. Include details of the collection environment or host for micro-organisms. Note: Attach further copies
of this table if there is insufficient room for your information below.
Item
Scientific name of taxon to
be collected and where
applicable, the collecting
environment (ie soil and
water for micro-organisms),
or the host taxon. State the
lowest taxonomic level known.
Common name (where known)
Conservation
status under the
Nature
Conservation Act
1992
EW = extinct in the
wild
E = endangered
R = rare
V = vulnerable
NT = near threatened
C = common
NL = not listed in NCA
Nature of sample to be
collected
Method of capture/collection
Non-lethal collection:
AF = fluid (animal)
AT = tissue (animal)
PB = bark
PG = gums/resin/exudate/sap
PR = root matter/rhizomes
PL = leaves/flowers
PF = fruit/spores/seeds
Lethal collection:
M = micro-organism
I=
aquatic invertebrate
T = terrestrial invertebrate
F = fish
RF = restricted fish
V = vertebrate (excludes fish)
P = whole plant/algae
FF = fungal fruiting body
O = other, please specify
Vertebrates or invertebrates:
NR = net and return
NE = net and euthanase
TR = trap and return
TE = trap and euthanase
CR = catch/collect and return
CE = catch/collect and/or euthanase
Invertebrates and micro-organisms:
S = soil sample
W = water sample
H = host organism
Plants, macro-algae, fungi:
HP = harvest or collect parts
HW = harvest whole
O = other, please specify
Insert extra lines as required.
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Table (ii)
Location of proposed collection sites for taxa listed in table 10(ii) (for examples refer to Question 10 and Attachment 3 of the Guideline -
Completing an application form for a Collection authority (Biodiscovery)).
Complete a new line for each combination of: taxon x sample x collection site. Note If your project involves vertebrates (other than fish), cephalopods or diseasecausing organisms, it will not be processed without appropriate ethics or biosafety committee approvals. Please attach copies of all relevant approvals. Also attach further
copies of this table to your application if there is insufficient room for your information below.
Item (from
10(i)
Proposed collection site/s (name of collection site location and GPS or lat/long co-ordinates)
Notes
Insert extra lines as required.
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Table (iii)
Aspects of proposed collection that are inconsistent with the Code (for examples refer to Question 10(iii) and Attachment 4 of the Guideline -
Completing an application form for a Collection authority (Biodiscovery)).
For all combinations of taxon x sample listed in 10(i): record details of your proposed inconsistent action, the Code section it relates to, and your
reasons for requesting the inconsistent action. Note: Please attach additional copies of this table if there is insufficient room below.
Item from
Proposed inconsistent action
10(i)
Code condition non-
Rationale
compliant with
Insert extra lines as required.
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Department of Environment and Heritage Protection
Application form
Collection authority (biodiscovery)
Declaration
Note: If you have not told the truth in this application you may be liable for prosecution under the relevant Acts
or Regulations.

I do solemnly and sincerely declare that the information provided is true and correct to the best of my
knowledge and I make this solemn declaration conscientiously believing the same to be true.

I understand that under the Biodiscovery Act 2004 the holder of a Collection authority (biodiscovery) is
responsible for all collection conducted under that authority, including activities carried out by their
agents.

All persons involved in the activities authorised by this authority will have the necessary licences,
permits, approvals and/or certifications (for example, current firearms licences and A-class Australian
Bird and Bat Banding Scheme endorsements), prior to undertaking any collection.
APPLICANT’S FULL NAME
APPLICANT’S SIGNATURE
DATE
IF APPLICANT IS A COMPANY OR PATNERSHIP, WHAT IS YOUR POSITON IN THE COMPANY OR PARTNERSHIP?
Checklist for attachments
Other applications, permits or approvals
attached as applicable, for example, animal
ethics committee application and approval,
Australian Bird and Bat Banding Scheme
endorsements, biosafety committee approvals, etc.
Proposed or approved biodiscovery plan
attached
Please return your completed application to:
Department of Environment and Heritage Protection
GPO Box 2454
Brisbane
Queensland 4001
Enquiries: 1300 130 372
Facsimile: (07) 3330 5875
Email: palm@ehp.qld.gov.au
Any additional pages to tables for Questions 9
or 10 attached
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Department of Environment and Heritage Protection