Page 1

Waste - Facility Access Request Form

Privacy

Privacy Collection Notice

This personal information in this form is collected by Toowoomba Regional Council for the purpose of assessing the request in this form and performing related functions. Council's privacy policy is available at tr.qld.gov.au/privacy.

Applicant type

The definitions of domestic and commercial waste can be found on the ' domestic waste versus commercial waste' webpage.

Is this a new application or a request to change details? *

New applicationExisting user - change of details

Is this application for a domestic or commercial user? *

DomesticCommercial

Commercial waste disposal at any of the locked access facilities is currently being reviewed by Council. By filling in this form you are submitting your interest to use the facility. Completing this form does not authorise the disposal of commercial waste at any of these waste facilities.

Waste facility location

Access to only one facility is permitted.

Which waste facility would you like access to use? *

Cecil PlainsCooyarEvergreenRavensbourne

Page 2

Waste - Facility Access Request Form

Property location

The property assessment number, lot and plan number can be found in the rates notice.

Property address

Street address *

Suburb

State

Postcode

Lot and plan

Lot number

Plan number

Reference number

Reference number

Property information

Are you the owner or occupier of the property? *

OwnerOccupier

Is there a dwelling on the property? *

YesNo

Is this your primary address as registered on the rates notice? *

YesNo

What is the address of your primary residence?

Street address

Suburb

State

Postcode

Property use

Do you operate a commercial business at the above property address or another property nearby? *

YesNo

Page 3

Waste - Facility Access Request Form

Applicant details

Title *

First name(s) - as per driver's licence *

Last name - as per driver's licence *

Phone number *

Date of birth

Driver's licence number

Alternative identification

Email address

Postal address

Suburb

State

Postcode

Additional users

Will more than one user require access? *

YesNo

Title *

First name(s) - as per driver's licence *

Last name - as per driver's licence *

Date of birth

Driver's licence number

Postal address

Suburb

State

Postcode

Page 4

Waste - Facility Access Request Form

Business details

Trading / business name

Australian Business Number (ABN) or Australian Company Number (ACN) and ANZIC if applicable

Business location

The reference number can be found on the rates notice.

Business address

Street address *

Suburb *

State *

Postcode *

Reference number

Reference number

Business postal address

Postal address

Suburb

State

Postcode

Page 5

Waste - Facility Access Request Form

Vehicle 1

Make *

Model *

Registration number *

Body type

Tonnes

RGVM / RGCM

Add vehicle

Vehicle 2

Make

Model

Registration number

Body type

Tonnes

RGVM / RGCM

Page 6

Waste - Facility Access Request Form

Declaration

Fees

There is no fee for this application.

Declaration

I understand and acknowledge that:

I agree to the terms and conditions.
The information provided in this application is true and complete to the best of my knowledge.
Council may refuse this application if it becomes evident that any information or supporting documents provided is incomplete or false.
Council is collecting and storing your personal information and personal information about other individuals on forms you submit in accordance with the Information Privacy Act and Council’s Privacy Policy. This is done for the purposes of processing your request for goods or services provided by ourselves as a Local Government. Where you provide personal information about other individuals, Council relies on you to inform those individuals that you are providing their personal information and to advise them of this statement.
I acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transactions (Queensland) Act 2001.

Agreement

I agree with the declaration *

Full name of applicant *

Date

Form process

After submitting this form, a Council officer will contact you to advise that your form has been received. This usually occurs within three working days.

Your application will then be reviewed and a PIN will be issued to allow access to the waste facility.

Save and Complete Later