Interested and Affected Parties Registration Form

Full name and surname:

Tel(w) Fax:

Tel(h):

Email:

Cell:

Postal Address:

Organisation and/or property decription (if landowner/lawful occupier):
Please state your interest in the proposed project:

Please assist by completing the questions below. These responses will be utilized to inform the Environmental Impact Assessment Process.

Are you a land owner or legal land occupier within the application area?
Are you aware of any tribal authorities within, or affected by, the application area, provide detail?
Are you aware of any other I&APs who need to be notified, please provide detail?
Please can you provide us with a description of the receiving environment? (including land uses such as farming, grazing etc.; vegetation; topographical features; Infrastructure; sensitive flora/fauna).
Are you aware of any land developments (current or proposed) within the application area that may be relevant to the proposed mining operation?
Are you aware of any cultural of heritage features within the mining area, please provide detail?
Please describe any bio-physical and/or socioeconomic impacts that you believe should be considered during the study?
Do you have any specific concerns or objections to the proposed project, if so could you please provide us with information?
General Comments:

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Interested and Affected Parties Registration Form

Please assist by completing the questions below. These responses will be utilized to inform the Environmental Impact Assessment Process.