<p>2013-14 Local Government Loan Borrowings</p><p>Application Checklist</p><p>This application checklist contains two pages. Sections marked with an asterix are mandatory. Please ensure both pages are completed. It is important that you review the “Local Government Borrowings for 2013-14” Bulletin (available on the Department’s website), prior to completing and submitting an application. This Bulletin provides detailed information on the Local Government loan borrowing program and application procedures. </p><p>Council </p><p>Application date</p><p>Total borrowings requested $</p><p>Requested Borrowings breakdown*</p><p>This section helps the Department understand to which major project areas, the proposed borrowings are planned to be allocated. Where Council does not know the exact dollar ($) breakdown by project area, the % approximation column can be used instead. Please cross out any project areas that are not relevant.</p><p>Major project areas ($) % of Total borrowings requested</p><p>Water %</p><p>Sewerage and Waste %</p><p>Roads, Drainage and Bridges %</p><p>Buildings and Community Assets %</p><p>Specific purpose %</p><p>Details of specific purpose (where applicable)</p><p>Required Documents*</p><p>Long-term financial forecast model has been included (CD / USB)</p><p>Adopted 2013-14 Debt Policy has been included</p><p>2013-14 Schedule of Capital Works has been included</p><p>This checklist (completed and signed) has been included</p><p>Page 1 of 2 Application Declarations*</p><p>FY2012 historical data in the long-term forecast model corresponds with 2011-12 audited Yes / No financial statements FY2013 historical data in the long-term forecast model corresponds with 2012-13 audited Yes / No financial statements (for applications submitted after completion of 2012-13 audit). Planned borrowings (incl. loan terms) have been appropriately represented in the long-term Yes / No forecast model and correspond with Council’s Adopted 2013-14 Debt Policy Long-term forecast model is not missing key assumptions, and a brief explanation of large Yes / No fluctuations in growth rates / forecast line items has been provided.</p><p>Yes / No Any approved borrowings will only be used for capital purposes</p><p>Projects proposed for funding form part of asset management planning processes and Yes / No whole of life project costs have been considered and included in the forecast model Long-term forecast model has been reviewed by QTC for completeness and Yes / No reasonableness (Optional)</p><p>Notes</p><p>Mayor & Chief Executive Officer (CEO) sign-off*</p><p>In signing this borrowing application, the Mayor and Chief Executive Officer (CEO) verify that the financial projections contained in the included long-term financial forecast model are the realistic intention of Council and that all loan funds will be applied to lawful, capital purposes and a native title risk assessment has been conducted on any relevant land. </p><p>Mayor sign-off</p><p>CEO sign-off</p><p>Signature Print name & date</p><p>Submission contact details*</p><p>Name</p><p>Position</p><p>Phone / E-mail</p><p>Page 2 of 2</p>