Rehabilitation Cost Estimate Submission Form
ESU-F02
This form must be used to submit a rehabilitation cost estimate as described in the
Rehabilitation Cost Estimate Guidelines (ESG 1)
Mine/project details
Mine/project name:
Insert mine/project name
Mine/project location:
Insert nearest town and major centre
Insert ML#/MC#/AL#/PAL#/PPL#/EL#/PEL#
Title(s):
NB: An RCE must include all titles within a group security.
Titleholder:
Insert mine/project titleholder name(s)
Operator:
Insert mine/project operator name
Contact details
Contact name:
Insert contact name
Position/title:
Contact company:
Insert contact company name
Contact address:
Insert contact address
Insert contact position/title
Telephone:
Insert contact phone number
Mobile:
Insert contact mobile phone number
Facsimile:
Insert contact fax number
Email:
Insert contact email address
Rehabilitation cost estimate details
Trigger for submission of a Rehabilitation Cost Estimate (tick a box):
Title grant
Title renewal
Title transfer
Title expiry
Title cancellation
Titleholder request
Department request
New or amended MOP/POP
AEMR
SMP
Exploration activity application – Category 3
Exploration activity notification (SDN) – Category 2
NB: An RCE must included with SDN’s if the cost of fulfilling rehabilitation obligations on the authorisation/title is
predicted to be greater than security deposit already held by DRE for the authorisation/title. New or amended
MOP/POP/SMP or Category 3 exploration activity applications must also be accompanied by a completed submission
form (ESU-F01) which is available on the website.
Name of plan the estimate is based on:
Insert MOP/PPOP/REF/EIS/SDN name
Methodology:
Department’s Rehabilitation Cost Schedules
Stage of disturbance:
Maximum disturbance within a MOP/PPOP/REF/SDN period
Snapshot of current disturbance
Period covered by the estimation:
Intended date of next
review:
Start date
Insert DD/MM/YYYY
Other
End date
Insert DD/MM/YYYY
Insert MM/YYYY
Current security held by the Department:
$####
Total of this rehabilitation cost estimate:
$####
Supporting documentation*
List any documents attached to this submission form
*1 hard copy and 1 electronic copy of all rehabilitation cost estimate documentation must be submitted
Certification
I certify that the information contained in this application is true.
Name:
Insert name of certifying person
Signature:
………………………………
Position/title:
Insert position/title of certifying person
Date:
Insert DD/MM/YYYY
NSW Trade & Investment
ESU-F02 Rehabilitation Cost Estimation Submission Form v1.1 (July 2012)
Page 1 of 2
www.resources.nsw.gov.au
Lodgment by mail
The Administration Officer
Environmental Sustainability Unit
Trade & Investment
PO Box 344
Hunter Region Mail Centre
NSW 2310
Lodgment by email
minres.environment@industry.nsw.gov.au (note that there is currently a 5MB size limit for lodgement by
email)
Lodgment in person
MAITLAND
516 High Street Maitland NSW 2320
SINGLETON
1 Civic Avenue Singleton NSW 2330
WOLLONGONG
84 Crown Street Wollongong NSW 2500
ORANGE
161 Kite Street Orange NSW 2800
BROKEN HILL
32 Sulphide Street Broken Hill NSW 2880
Enquiries
Phone:
Fax:
Email:
Web:
(02) 4931 6605
(02) 4931 6790
minres.environment@industry.nsw.gov.au
www.resources.nsw.gov.au
Office Use Only
Date Received
Trim Reference: PUB12/113
Receiving Officer
Referred to
NSW Trade & Investment
ESU-F02 Rehabilitation Cost Estimation Submission Form v1.1 (July 2012)
Page 2 of 2
www.resources.nsw.gov.au