1978
(r. 140)
APPLICATION FOR FORFEITURE UNDER SECTION
96(1)(b) OR 98 No.
Before the Warden at
(a)
Name and address of applicant
Applicant for forfeiture
(a)
V
(b)
Name and address of tenement
holder (for service)
Respondent
(b)
(c)
Mining tenement number
The Applicant claims that
the Respondent has failed to comply with the expenditure conditions
in relation to
(c)
(d)
Relevant year for the year ending
—
(d)
and applies for the mining tenement to be forfeited.
DATED this
............
day of
.....................
20
......
(e)
Signature of applicant/lawyer/authorised representative
(see
Note 1)
(e
)......................................................................................
(f) Address for Service
(f) ........................................................................
...
........................................................................
....
Tel ...
.............................
Fax ...
...........................
......
Email ...
........................ Ref (if any) .....................
......
STAMP OF MINING
REGISTRAR
OFFICIAL USE
SUMMONS TO RESPONDENT
YOU ARE HEREBY REQ
UIRED TO ATTEND A MENTION
HEARING ( see Note 2) before the Warden at
..................... at ....................a.m
. /
p.m. on the ...............
day
of ...
...
........
.......20.....
to answer the application for forfeiture as outlined above.
TAKE NOTICE
that if you intend to dispute the applicant’s
claim YOUR RESPONSE in the form of
FORM 36
must be
filed
within 14 days
of being served with this application ( see
Note 3).
Received
at ...
...........a.m./p.m. on the ................. day of
......................... 20 .... with the prescribed application fee.
...........................................................................
Mining Registrar
