Form 171 - Amalgamation of Piped Water District Properties

Form 171 - Amalgamation of Piped Water District Properties

Use this form when making an application to amalgamate two or more services (properties) of a Piped Water District.

Assistance with completing this form

Before you start

  • Have you read the accompanying explanatory notes and referred to the current fee schedule (which can be obtained by calling 1800 013 357 or downloaded from www.g-mwater.com.au)
  • Are the properties owned and operated as a single farming and financial enterprise.

Essential background information

  • Amalgamated properties will reduce total service charges payable.
  • Properties must be owned and operated as a single farming and financial enterprise.
  • I/We make this application on the full understanding that at any time in the future if the holdings are to be recognised separately a subdivision will be required and will be required to meet the then current investigation and other fees including the cost of any works which may be required under the subdivision.

Please note that if more than 6 signatures are required per group (e.g. Owners, Licensees, Sellers, Buyers, Transferees) please contact GMW to request an offline form.

Applicant details

Please note that all communication related to this form will be directed to the Applicant or Lodging Party.

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”.

Select date...

This email address will receive all automated correspondence in relation to this form submission.

Postal address
Application details
Licenced properties to be amalgamated
Licence 1

Found on Fixed Charges Account.

If more than 6 signatures are required, please contact GMW to request an offline form.

Applying as a company

Please note when applying as  a company:

  • The form must be signed by 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:

  • Accessing the internet service at www.asic.gov.au (opens in a new window) or by phoning (03) 5177 3988
  • Contacting your solicitor or legal advisor to conduct the search on your behalf (fees may apply)
  • Requesting that GMW complete the searches on your behalf (fees apply)

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

Licence 1 - Licensee 1
Applicant is Licence 1 - Licensee 1 This is a required field.
Applicant is Licence 1 - Licensee 1 This is a required field.
Type This is a required field.
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
Select date...
Postal address
Licence 1 - Licensee 2
Type This is a required field.
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
Select date...
Postal address is the same as Licence 1 - Licensee 1 This is a required field.
Postal address is the same as Licence 1 - Licensee 1 This is a required field.
Postal address
Licence 1 - Licensee 3
Type This is a required field.
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
Select date...
Postal address is the same as Licence 1 - Licensee 2 This is a required field.
Postal address is the same as Licence 1 - Licensee 2 This is a required field.
Postal address
Licence 1 - Licensee 4
Type This is a required field.
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
Select date...
Postal address is the same as Licence 1 - Licensee 3 This is a required field.
Postal address is the same as Licence 1 - Licensee 3 This is a required field.
Postal address
Licence 1 - Licensee 5
Type This is a required field.
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
Select date...
Postal address is the same as Licence 1 - Licensee 4 This is a required field.
Postal address is the same as Licence 1 - Licensee 4 This is a required field.
Postal address
Licence 1 - Licensee 6
Type This is a required field.
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
Select date...
Postal address is the same as Licence 1 - Licensee 5 This is a required field.
Postal address is the same as Licence 1 - Licensee 5 This is a required field.
Postal address
Licence 2

Found on Fixed Charges Account.

If more than 6 signatures are required, please contact GMW to request an offline form.

Applying as a company

Please note when applying as  a company:

  • The form must be signed by 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:

  • Accessing the internet service at www.asic.gov.au (opens in a new window) or by phoning (03) 5177 3988
  • Contacting your solicitor or legal advisor to conduct the search on your behalf (fees may apply)
  • Requesting that GMW complete the searches on your behalf (fees apply)

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

Licence 2 - Licensee 1
Type This is a required field.
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
Select date...
Postal address
Licence 2 - Licensee 2
Type This is a required field.
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
Select date...
Postal address is the same as Licence 2 - Licensee 1 This is a required field.
Postal address is the same as Licence 2 - Licensee 1 This is a required field.
Postal address
Licence 2 - Licensee 3
Type This is a required field.
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
Select date...
Postal address is the same as Licence 2 - Licensee 2 This is a required field.
Postal address is the same as Licence 2 - Licensee 2 This is a required field.
Postal address
Licence 2 - Licensee 4
Type This is a required field.
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
Select date...
Postal address is the same as Licence 2 - Licensee 3 This is a required field.
Postal address is the same as Licence 2 - Licensee 3 This is a required field.
Postal address
Licence 2 - Licensee 5
Type This is a required field.
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
Select date...
Postal address is the same as Licence 2 - Licensee 4 This is a required field.
Postal address is the same as Licence 2 - Licensee 4 This is a required field.
Postal address
Licence 2 - Licensee 6
Type This is a required field.
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
Select date...
Postal address is the same as Licence 2 - Licensee 5 This is a required field.
Postal address is the same as Licence 2 - Licensee 5 This is a required field.
Postal address
Licence 3

Found on Fixed Charges Account.

If more than 6 signatures are required, please contact GMW to request an offline form.

Applying as a company

Please note when applying as  a company:

  • The form must be signed by 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:

  • Accessing the internet service at www.asic.gov.au (opens in a new window) or by phoning (03) 5177 3988
  • Contacting your solicitor or legal advisor to conduct the search on your behalf (fees may apply)
  • Requesting that GMW complete the searches on your behalf (fees apply)

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

Licence 3 - Licensee 1
Type
Type
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
Licence 3 - Licensee 2
Type This is a required field.
Type This is a required field.
Company details

Please see notes above on applying as a company.

Contact details
Select date...
Postal address is the same as Licence 3 - Licensee 1 This is a required field.
Postal address is the same as Licence 3 - Licensee 1 This is a required field.
Postal address
Licence 3 - Licensee 3
Type This is a required field.
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
Select date...
Postal address is the same as Licence 3 - Licensee 2
Postal address is the same as Licence 3 - Licensee 2
Postal address
Licence 3 - Licensee 4
Type This is a required field.
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 Licence 3 - Licensee 3 This is a required field.
Postal address is the same as Licence 3 - Licensee 3 This is a required field.
Postal address
Licence 3 - Licensee 5
Type This is a required field.
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
Select date...
Postal address is the same as Licence 3 - Licensee 4 This is a required field.
Postal address is the same as Licence 3 - Licensee 4 This is a required field.
Postal address
Licence 3 - Licensee 6
Type This is a required field.
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
Select date...
Postal address is the same as Licence 3 - Licensee 5 This is a required field.
Postal address is the same as Licence 3 - Licensee 5 This is a required field.
Postal address
Additional Properties

List any additional Account Numbers and Property Owners.

Property Title details

Volume / Folio / Lot No / Plan No / Crown Allotment / Section / Parish

Declarations
Applicant Declaration This is a required field.
Applicant Declaration This is a required field.
Signatures
  • When you submit this form, invitation emails will be sent to all signatories requesting that they review and sign your submission
  • You will be notified each time a signature has been submitted
  • You will receive a request for payment (if applicable) when the final signature has been submitted

If you are signing this form and not representing a company, please enter N/A in Position.

Licence 1, Licensee 1 Sign Here
Sign Here
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
Select date...

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.