Form 141 - Irrigation District - Supply by agreement

Form 141 - Irrigation District - Supply by agreement

Use this form when making application to issue or cancel and re-issue a supply by agreement

This application will expire on 30 June.

Applicant or Lodging Party details

The Applicant is the person who is submitting the application to GMW, they are the main contact for that form submission and are responsible for the information being submitted and the coordination of e-signatures and payment of the application fee.

The Applicant may be a lodging party/ solicitor/ conveyancer/ water broker but can also be a new or existing customer submitting their own application form as  the seller/buyer or licensee.

If the property transferring includes a general place of take and/or extraction share, this will be included on the application form

Every application requires an “applicant”.

When you save a draft the Applicant Email Address will receive an email with a link back to the partially completed form.

Postal address
Application details
Application Type This is a required field.
Application Type This is a required field.
Details of the land(s) where the water is to be used

Please list the Volume / Folio / Lot No / Plan No / Crown Allotment / Section / Parish

Ownership of the land(s)

If you need to capture the details of more than 6 people, please contact GMW to request an offline form.

Applying as a Company

Please note when applying as a company:

  • You must provide the details of those persons duly authorised to sign on behalf of the company in accordance with section 127(1) of the Corporations Act 2001; two directors, alternatively one director and one secretary, unless there is a sole director and secretary of the company.
  • A current (less than 12 months old) copy of an ASIC Company Search listing all directors and/or office bearers must be provided.

You can obtain a Company Extract by:

You must provide the details of those persons duly authorised to sign on behalf of the company.

Applicant 1
Applicant or Lodging Party is Applicant 1 This is a required field.
Applicant or Lodging Party is Applicant 1 This is a required field.
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address
Applicant 2
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address is the same as Applicant 1? This is a required field.
Postal address is the same as Applicant 1? This is a required field.
Postal address
Applicant 3
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address is the same as Applicant 2? This is a required field.
Postal address is the same as Applicant 2? This is a required field.
Postal address
Applicant 4
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address is the same as Applicant 3?
Postal address is the same as Applicant 3?
Postal address
Applicant 5
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address is the same as Applicant 4? This is a required field.
Postal address is the same as Applicant 4? This is a required field.
Postal address
Applicant 6
Applicant Type This is a required field.
Applicant Type This is a required field.
Company details

Please see notes above on applying as a company.

Attach a current (less than 12 months old) Company Extract.

Contact details
Postal address is the same as Applicant 5? This is a required field.
Postal address is the same as Applicant 5? This is a required field.
Postal address
Source of supply
Agreement details
Select date...
Purpose of the Agreement This is a required field.
Purpose of the Agreement This is a required field.
Extraction Method This is a required field.

How will the water be extracted?

Extraction Method This is a required field.
Declarations
Declaration 1 This is a required field.
Declaration 1 This is a required field.
Declaration 2 This is a required field.
Declaration 2 This is a required field.
Payment
Save draft

Please ensure that the information provided in this form is correct as it cannot be modified after it is submitted.

If needed, you are able to save a draft and come back to the form via a link that will be emailed to you.

Submit

Protecting your privacy

Goulburn-Murray Water (GMW) protects your privacy by collecting and handling your personal information in accordance with the requirements of the Privacy & Data Protection Act 2014. Your personal information is collected on this form and will be used for the purpose of administering this application, updating our records and updating the Victorian Water Register (if applicable). Information collected is usually disclosed to staff involved in processing your application, contractors, connection staff, other relevant GMW staff and government departments. Failure to provide the information sought may result in processing delays or non acceptance of your application. It may also limit our ability to be able to provide various programs or services. You may gain access to and correct your personal information. For further information please refer to our Privacy Policy at www.g-mwater.com.au or call 1800 013 357 to obtain a copy of this policy.