Please complete all questions and provide supporting documentation that shows you meet the requirements set within the National Parks and Wildlife Act.

To be completed and signed by an authorised representative of the Aboriginal elders group (NPW Act Schedule 9, clause 1(2)(d)(i))

Native title holders within the meaning of the Native Title Act 1993 of the Commonwealth or registered native title claimants NPW Act Schedule 9, clause 1(2)(d)(ii).

If you are a native title holder, please provide the following details:

If you are a registered native title claimant, please provide the following details:

Note: If during your appointment on Aboriginal Cultural Heritage Advisory Committee your native title claim is dismissed, withdrawn or for any reason removed from the register, your appointment will no longer be valid. In that event, you must immediately report the change in your circumstances to Heritage NSW.

Aboriginal owners listed on the register under the Aboriginal Land Rights Act 1983.

Members of the community, including women, Aboriginal and Torres Strait Islander people, people of culturally diverse backgrounds, people with a disability and young people, are encouraged to apply for positions on NSW boards and committees.

Please list 2 professional references.

I certify that my answers are true and complete to the best of my knowledge.

I approve the NSW Government undertaking the following probity checks, as deemed appropriate for applications to this Council: ASIC Banned and Disqualified search, ASIC Enforceable Undertakings Register search, Australian Financial Security Authority National Personal Insolvency Index search, NSW Police Force National Police Check and Office of the Children's Guardian Working with Children Check.

I acknowledge that if I am approved for appointment or reappointment to Aboriginal Cultural Heritage Advisory Committee, that I will be required to declare pecuniary/non-pecuniary interests.