DEPARTMENT OF MINES AND ENERGY
Amalgamated Reporting – Application and Amendment
Amalgamated Report Number:
MTA Approved Form 18
Section 94(3)(d), Regulation 87
GR:
(if new application leave blank)
AMALGAMATED REPORTING
APPLICATION AND AMENDMENT
Type of Amalgamated Report:
Expenditure
Mining Management and Annual Reports
Annual (technical)
Indicate if this is a new Application, or an Amendment to an existing Amalgamated Reporting approval:
Application
Amendment
APPLICANT DETAILS
Company:
Date:
Postal Address:
Contact Name:
Phone Number:
Fax Number:
Email:
AMALGAMATED REPORTING – ANNUAL AND EXPENDITURE
Name of title Group / Project name:
GR No.:
Geological province targeted:
Commodity/s targeted:
Describe targeted mineralisation style or geological model:
MINING MANAGEMENT AND ANNUAL REPORTS
Current MMA Report due date:
Current Annual Report due date:
PROPOSED AMALGAMATED REPORTING SUBMISSION DATES
Preferred reporting date:
Amalgamated reporting period: from
(as nominated by operator)
Amalgamated Reporting – Application and Amendment (r1)
to
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Northern Territory Government, 09/12/2011
PROPOSED AMALGAMATED AREA
Provide a complete list of titles to be amalgamated or withdrawn and ownership of each title (attach a list if
there is not enough space). State relationships of relevant bodies corporate, or related ownership if titles are
held in different names. If this is a new application all entries in final column will be ‘A’, addition.
Title number:
Addition (A) /
Withdrawal (W)
Title holder:
Provide a map showing each title to be added or withdrawn, as well as any titles in an existing group, labelled
with the title number overlying a solid geology map.
NTGS USE ONLY
Date received:
Date actioned:
accept fully / accept partially / reject
Comments:
PRIVACY STATEMENT
The Department of Resources is seeking information from you for the purposes of assessing your application under Regulation 87 of the
Mineral Titles Act . This information will be kept confidential except as required by law.
This application form must be submitted via email to: geoscience.info@nt.gov.au
Further information is available at www.minerals.nt.gov.au or (08) 8999 6443
Amalgamated Reporting – Application and Amendment (r1)
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Northern Territory Government, 09/12/2011