TO:	The Director General,
	Australian Safeguards and Non-Proliferation Office

	The following application is hereby made for the granting of a permit under sub‑section 16B of the Nuclear Non-Proliferation (Safeguards) Act 1987, to decommission a uranium mine and concentration plant.

	NOTE:
	This application or subsequent approval does not diminish or relinquish the Permit Holder’s obligations under their current permit to possess nuclear material

– PLEASE READ THE INSTRUCTIONS –

(A)	What is the name of the current Permit Holder? (see Instruction 2)
	
ABN / ACN:		
Current Permit Number(s):		
(B)	What will the Permit Holders contact details be until end of decommissioning?
Street Address:	Postal address:	

	
Phone:	(	)		Fax:	(	)		
(C)	Who is the Permit Holders Representative for ALL aspects related to maintaining the current permit conditions and during decommissioning (see Instruction 3)
	
(D)	What are the Permit Holder Representative’s contact details?
Mob Phone:   	Position:  	
Office Phone:	( 	)		Fax:	( 	)		
Email address:		
Note:	ASNO requires notification of changes to the Permit Holder Representative during decommissioning.
If the Permit Holder has a detailed Decommissioning or Closure Management Plan that includes the key criteria (Questions E to K) then attach this to the application and only refer to the relevant section(s) in the attached plan.	(Expand tables as required)
(E)	Provide a short description of the reason(s) for decommissioning. 
	
(F)	Decommissioning Dates. (see Instruction 4)
Start Date:   	Estimated Completion Date:   	
Nuclear Material Accounting
(G)	Provide a description of ALL actions to be taken to reduce the current holdings of uranium ore concentrates holdings to zero. (See Instruction 5)
	
Equipment / Plant Management
(H)	Provide a description of plan for treatment/dispositioning of uranium residues 
(See Instruction 6)
	
(I)	Provide a detailed description of Decommissioning milestones:
	
Physical Security Management
(J)	Provide a detailed description of physical security measures to be maintained during decommissioning activities.
	
(K)	Describe how access to the site for ASNO and IAEA inspections will be assured
	
(L)	Describe any other relevant information
	
(M)	What is the name, address and telephone number of the person authorised by the applicant to provide additional information in relation to this application?
Name:  	
Street Address	Postal address	
		
Phone:	(	)		Fax:	(	)		
Email address:		
(N)	SIGNED BY, OR ON BEHALF OF, THE APPLICANT:
** The signatory below must have organisational authority to represent the applicant and to implement the conditions of the permit when granted **
	
Name :			
	
Position:			
	    Signature:	___________________________	Date:	____/____/________	

INSTRUCTIONS

1.	This application should be submitted after the applicant has made a decision that the facility producing uranium ore concentrates will be decommissioned and before any work is carried out to decommission the whole or part of the facility.
2.	If the application is being made by, or on behalf of, a corporation, organisation or legal entity, the name of the corporation, organisation or legal entity is to be inserted at question (A).  Do not insert the name of the person signing the application; this must happen at question (M). 
3.	Permit Holders Representative means the representative of the Permit Holder (i.e. the organisation) who will take responsibility and sign documents on behalf of the organisation. This person must be in a position with sufficient authority to ensure all permit conditions are met.
4.	Decommissioning  means administrative and technical actions taken at the end of the operating lifetime of a facility to:
i.	allow for the removal of all or some of the regulatory controls from a facility that typically includes dismantling of the facility (or part thereof);  
ii.	retire from service, with due regard for the health and safety and the long term protection of workers, members of the public and the environment; or
iii.	have no further foreseen use of the facility (or part thereof) for its existing purpose. (A facility however, could be decommissioned without dismantling and existing structures subsequently put to another use (after decontamination) or incorporated into a new or existing facility, or even if the site on which it is located is still under regulatory or institutional control.)
5.	Including all drummed uranium product and samples and other sources of uranium of concentration greater than 50% w/v.
6.	This includes uranium residues and slurry present in tailings and processing stages such as solvent extraction, ion-exchange, precipitation, drying and calcination.
7.	Where there is insufficient space on this form to furnish complete information, additional information must be provided on separate sheets, numbered consecutively and signed by, or on behalf of, the applicant.
8.	ASNO’s contact details (for submission of application):
Phone:	(02) 6261 1920
Email:	nuclear.asno@dfat.gov.au
Postal address:	The Director General
	Australian Safeguards and Non-Proliferation Office
	R.G. Casey Building
	John McEwen Crescent
	Barton ACT 0221