Application form
Section 14(b) – Nature Conservation (Administration) Regulation 2006
OFFICIAL USE ONLY
DATE RECEIVED
Protected plant harvesting licence
FILE REF
Important information for applicants
PROJECT REF
COMPLETE FORM
COMPLETE FEE
CORRECT AA
CONCESSION FEE
ADMINISTERING DISTRICT
ENTERED BY [SIGNATURE]
DATE
This form is to be used to apply for a protected plant harvesting licence.
Information requested will enable your application to be processed as
prescribed by the Nature Conservation Act 1992. Your application must be
assessed and a permit granted by the chief executive before you can proceed
with the proposed activity. Your application may take up to 40 days to process.
Before completing your application please read the information materials
included with your application kit. Before lodging this application you should be
familiar with the requirements of the Nature Conservation Act available on the
Office of the Queensland Parliamentary Counsel website
http://www.legislation.qld.gov.au. If you have queries about how to complete
this form correctly or need guidance contact Permit and Licence Management
on 1300 130 372.
Fees and concessions
In accordance with section 144 of the Nature Conservation (Administration) Regulation 2006, reduced fees
are available for particular applications. Does the application relate to one of the following purposes?
An educational purpose; or
A scientific research purpose; or
An activity directed at conservation; or
Clearing to establish necessary property infrastructure; or
A traditional owner activity.
See section 144 of the Nature Conservation (Administration) Regulation 2006 for definitions of the eligible purposes.
In accordance with section 155 of the Nature Conservation (Administration) Regulation 2006, a fee exemption
is available for particular applications. Is the applicant is one of the following;
A recreational plant society
A voluntary conservation organisation
A volunteer community organisation
See section 155 of the Nature Conservation (Administration) Regulation 2006 for definitions of eligible applicants.
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ABN 46 640 294 485
Application form
Protected plant harvesting licence
PART A – LICENCE APPLICATION
1. Applicant information
A permit may only be granted to an individual or corporation. Please tick the appropriate box:
AN INDIVIDUAL
Complete Section 2 applicant details — then complete sections 4 to 14
A CORPORATION 
Complete Section 3 applicant details — then complete sections 4 to 14
2. Applicant details for an individual
APPLICANT’S FAMILY NAME
TITLE
APPLICANT’S GIVEN NAME/S
DATE OF BIRTH
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
FACSIMILE
POSTAL ADDRESS (WRITE ‘AS ABOVE’’ IF SAME AS RESIDENTIAL ADDRESS)
POST CODE
3. Application details for corporations
REGISTERED LEGAL ENTITIY NAME (NOT A BUSINESS TRADING NAME)
TRADING NAME/S (IF APPLICABLE)
REGISTERED BUSINESS ADDRESS (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE (BUSINESS HOURS)
FACSIMILE
EMAIL
WEBSITE
POSTAL ADDRESS (WRITE ‘AS ABOVE’ IF SAME AS BUSINESS ADDRESS)
POST CODE
ABN / ACN / AN, OR TITLE AND SECTION OF LEGISLATION UNDER WHICH CORPORATION HAS LEGAL STATUS
NAME OF PRINCIPAL OF CORPORATION
SIGNATURE OF PRINCIPAL OF CORPORATION (or person authorised to sign on their behalf)
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DATE
Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
Details of nominated person in charge where the authorised activity is to be undertaken
NOMINATED CONTACT PERSON’S FAMILY NAME
TITLE
NOMINATED CONTACT PERSON’S GIVEN NAME/S
DATE OF BIRTH
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
FACSIMILE
POSTAL ADRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL ADDRESS)
POSTCODE
4. Have you previously held this type of permit?
This may include permits in other States.
Yes
No
If yes, state the permit number (if known)
5. What is the purpose of the harvest?
PLANT PARTS
WHOLE PLANTS
Sustainable harvest of protected plant parts
Sustainable harvest of whole protected plants
Salvage of whole protected plants
6. Plant details
What plants does the application refer to?
(If you require more space, attach a separate sheet of plant details)
SCIENTIFIC NAME
COMMON NAME
CONSERVATION
STATUS
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L – LIVING
D – DEAD
P – PARTS/
PRODUCTS
(describe type of
part)
QUANTITY
Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
7. Sustainable harvest plan
A sustainable harvest plan is required for the harvest of all endangered, vulnerable, near threatened or special
least concern plants, as listed in section 6 of this application (refer to section 11 for attachment requirements). If
the application is for the salvage of whole plants only, a sustainable harvest plan is not required.
Has a sustainable harvest plan been prepared in accordance with the protected plants assessment guideline?
Yes
No
8. Harvest of forest products
Does the activity involve harvest of forest products under the Forestry Act 1959?
Yes
No
If yes, do you have a forestry permit or licence, sales permit, or other resource entitlement?
Yes
No
Please note that an approval under the Forestry Act 1959 is required prior to the approval of a protected plants harvesting
licence.
9. What property or properties do you intend to take plants from?
(If you require more space, attach a separate sheet)
LOT ON PLAN DESCRIPTION AND ADDRESS
LOCAL GOVERNMENT NAME
PARISH NAME
10. Place of keeping plants
ADDRESS
Are protected plants to be used for trade?
POSTCODE
Yes
No
Note: Requirements for trading in protected plants are listed under the Nature Conservation Wildlife Management Regulation
Part 3 Division 6.
11. Attachments
List all attached documents, including maps containing information supporting this application in the space
below.
1)
A spatial representation of where protected plants are proposed to be harvested from, if not otherwise included in a
sustainable harvest plan.
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Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
2)
A sustainable harvest plan, prepared in accordance with the protected plants assessment guideline must be attached,
unless the application is for the salvage of whole plants only (where applicable); and
3)
Other documents including maps containing information to support this application may also be attached if necessary
(where applicable).
Note: A sustainable harvest plan is a plan about the harvest of protected plants listed in section 6 of this application, and the
ecological sustainability or benefits of the harvest. The sustainable harvest plan must be prepared in accordance with the
protected plants assessment guideline. A sustainable harvest plan is not required if the harvesting licence is in relation to
contingent salvage harvest only.
ATTACHMENTS (LABEL ALL ATTACHMENTS ALPHABETICALLY E.G. “ATTACHMENT A”)
12. Applicant suitability
The licence may be granted if the applicant is an appropriate person to hold the licence, that is, if the applicant
has the ability to carry out activities under the authority in a competent and ethical way.
QUESTIONS
DETAILS
1. During the past 10 years have you ever (in
Queensland or elsewhere) been found guilty of any
criminal offence or entered a plea of guilty in a Court?
YES
NO
YES
NO
(Note: does not include simple traffic offences such as
parking, speeding.) If yes, provide details of the offence/s.
2. Have you ever had an equivalent permit from another
State or country that was suspended and/or cancelled? If
yes, provide details about the permit, the date it was
suspended and/or cancelled and reasons for
suspension/cancellation.
13. Privacy statement
Information you provide on this form is being collected by the Department of Environment and Heritage
Protection to process and administer your application for a Protected plant harvesting licence, as authorised
under section 14(b) of the Nature Conservation (Administration) Regulation 2006. Some information may be
provided to the Departments of National Parks, Recreation, Sport and Racing; Agriculture, Fisheries and
Forestry; or Health in order to investigate allegations of unlawful activity, biosecurity or health issues, if required.
Information regarding your status as a holder of this type of permit may be provided to any party upon request.
Your personal information will not be disclosed to any other parties unless authorised or required by law. More
information on our commitment to privacy is available on our website:
http://www.ehp.qld.gov.au/legal/privacy.html.
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Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
14. 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 all information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
APPLICANT’S NAME
APPLICANT’S SIGNATURE
DATE
IF THE APPLICANT IS A CORPORATION, PLEASE INDICATE YOUR POSITION IN THE CORPORATION
PART B – LANDHOLDER STATEMENT
This section demonstrates landholder permission for the harvest of protected plants. The landholder and the
applicant for a protected plant harvesting licence should be familiar with a Harvest Period Notice current at the
time of application, if applicable.
This section also applies to a salvage activity when lodging a protected plant harvesting licence application for
the salvage of protected plants to provide assurance from the landholder that their land will be lawfully cleared
for an activity approved under an Act.
Is the applicant the landholder of the land?
YES
NO
The applicant or the landholder of the land must complete this section.
Landholder name(s)
LANDHOLDER NAME(S):
Contact person for the landholder
CONTACT NAME:
Contact person’s details
POSITION:
FULL POSTAL ADDRESS:
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Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
TELEPHONE:
(
FACSIMILE:
)
EMAIL:
Plant harvest details
THE PURPOSE OF THE HARVEST AND THE LIST OF PLANTS TO BE HARVESTED UNDER THE PROTECTED PLANT HARVESTING LICENCE.
Landholder certificate
I,
PRINTED NAME OF TENEMENT HOLDERS
Authorise the applicant to harvest plants from the land, and
If the application is for protected plant harvesting for the salvage of whole plants only – state that the part of
the land in which the plants are located is to be lawfully cleared by an approved activity assessed under an
Act, and
State that information supplied above is, to the best of my knowledge, true and accurate.
SIGNATURE
POSITION OF SIGNATORY (E.G. DIRECTOR, MANAGER, OWNER, PARTNER, CEO ETC.):
DATE:
PART C- APPLICANT CHECKLIST
Application form completed and signed
Please return to:
Fees paid or enclosed
Permit and Licence Management
Spatial representation of plants subject to
harvest (if applicable)
Department of Environment and Heritage Protection
Sustainable harvest plan (if applicable)
GPO Box 2454
Brisbane Qld 4001
Enquiries: 1300 130 372
Other documentation (if applicable)
Privacy statement acknowledged
Facsimile: (07) 3330 5875
E-mail: palm@ehp.qld.gov.au
Please make all cheques payable to EHP.
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Department of Environment and Heritage Protection
Application form
Protected plant harvesting licence
The Nature Conservation (Wildlife Management) Regulation 2006 may be obtained from the Office of
Queensland Parliamentary Counsel website http://www.legislation.qld.gov.au
Code of Practice or guidelines and Information sheet – Wildlife authorities and privacy may be obtained from the
EHP website http://www.ehp.qld.gov.au/licences-permits/plants-animals or by contacting the EHP Referral
Centre on 1300 130 372.
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Department of Environment and Heritage Protection