Appendix A: Form 17
Form 17 - Application to become requiring authority
Section 167, Resource Management Act 1991
To the Minister of the Environment
c/- Ministry for the Environment
Wellington
[Full name] applies for approval to become a requiring authority.
[Full name of applicant] is a network utility operator as defined in section 166 of the Resource Management Act 1991 because:
[give evidence of how the applicant qualifies as a network utility operator, including full details of any Order in Council or other instrument that establishes the applicant as a network utility opera-tor].
The application relates to the following project or work (or network utility operation):
[give a full description, including the location(s) of the project or work or network utility operation (with maps). Include the name of the territorial authorities in whose district the project or work or network utility operation will occur].
Approval of this application is appropriate for the purposes of carry-ing out that project or work (or network utility operation) because:
[state the applicant's objectives, duties, and responsibilities and how the project or work or network utility operation relates to them. Also state any consequences for the applicant in achieving those objec-tives, duties, and responsibilities if approval is declined].
[Full name of applicant] will carry out all the responsibilities (including financial responsibilities) of a requiring authority under the Resource Management Act 1991 and will give proper regard to the interests of those affected and to the interests of the environment in the following way:
[give details as to how the applicant will meet these responsibilities and of the applicant's ability to meet these financial responsibilities (including examples of the applicant's business history). If possible, include a copy of the applicant's latest annual report or other financial statements and any of the applicant's environmental and consultation policies].
Form 17 - continued
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Signature or applicant
(or person authorised to sign
on behalf of applicant)
..................................................
Date
Address for service of applicant:
Telephone:
Fax/email:
Contact person: [name and designation, if applicable]
Note to applicant
You must pay the application fee set out in Schedule 2 of the Resource Management (Forms, Fees, and Procedure) Regulations 2003 with this application.
