To (Name of consent authority)
Submission on (Name of proposed policy statement or plan)
Name: (Full name)
Address: (Full postal address)
....................................................................
(Signature of person making submission or person authorised to sign on behalf of person making submission)
....................................................................
(Date)
Address for service of person making submission:
....................................................................
....................................................................
Telephone No: ....................................................................
Fax No: ....................................................................
Contact person: (Name and telephone number if different from above)
Note
A copy of your submission must be served on the applicant as soon as reasonably practicable after service of your submission on the consent authority.