2015-16 Local Government Loan Borrowings
Application Checklist
This application checklist contains two pages. Sections marked with an asterisk (*) are mandatory. Please ensure
both pages are completed. It is important that you review the Local Government Borrowings for 2015-16 Bulletin
(available on the Department’s website), prior to completing and submitting an application. This Bulletin provides
detailed information on the local government loan borrowing program and application procedures.
Council
Application date
Total borrowings requested
$
Requested Borrowings breakdown*
This section helps the Department understand to which major project areas the proposed borrowings are planned
to be allocated. Where the Council does not know the exact dollar ($) breakdown by project area, the %
approximation column can be used instead. Please cross out any project areas that aren’t relevant.
Major project areas
($)
% of Total borrowings requested
Water
%
Sewerage and Waste
%
Roads, Drainage and Bridges
%
Buildings and Community Assets
%
Specific purpose
%
Details of specific purpose (where
applicable)
Required Documents*
Long-term financial forecast model has been included (CD / USB)
Adopted 2015-16 Debt Policy has been included
2015-16 Schedule of Capital Works has been included
This checklist (completed and signed) has been included
Application Declarations*
Yes / No
FY2014 historical data in the long-term forecast model corresponds with 2013-14 audited
financial statements.
Yes / No
FY2015 historical data in the long-term forecast model corresponds with 2014-15 audited
financial statements (for applications submitted after completion of 2014-15 audit).
Yes / No
Yes / No
Planned borrowings (including loan terms) have been appropriately represented in the
long-term forecast model and correspond with the Council’s Adopted 2015-16 Debt Policy.
Long-term forecast model is the QTC LGFM v3.0.2, and is not missing key assumptions,
and a brief explanation of large fluctuations in growth rates / forecast line items has been
provided.
Yes / No
Any approved borrowings will only be used for capital purposes.
Yes / No
Projects proposed for funding form part of asset management planning processes, and
whole of life project costs have been considered and included in the forecast model.
Yes / No
Long-term forecast model has been reviewed by QTC for completeness and
reasonableness (Optional).
Notes
Mayor and Chief Executive Officer (CEO) sign-off*
In signing this borrowing application, the Mayor and Chief Executive Officer (CEO) verify that the financial
projections contained in the included long-term financial forecast model are the realistic intention of the Council
and that all loan funds will be applied to lawful, capital purposes, and a native title risk assessment has been
conducted on any relevant land.
Mayor sign-off
CEO sign-off
Signature
Submission contact details*
Name
Position
Phone / E-mail
Print name and date