Tasmanian Freight Equalisation Scheme King Island and Furneaux Group intrastate component Manufacturers’ and Miners’ Application for approval of items Claimant Name 1 Details of items to be registered — Explanatory notes 1 Item—Each item for which assistance is sought must be registered separately. General descriptions (e.g. hardware, essences, components) cannot be accepted – a schedule of items may be attached if necessary. 2 Detailed description of use of item in process —A general description including how/where the item is used in the Claims Agent Name (if applicable) manufacturing process, to enable eligibility to be determined (e.g. flour, as a material input to bread making). 3 Name and address of manufacturer—A Manufacturer’s Certificate form (TAS027), completed by the manufacturer stating where the item was made, must be submitted with this application. If the item(s) were not CLK0TAS026 1810 Claimant Code manufactured/produced on the mainland of Tasmania, you must also provide a letter from the manufacturer detailing any processing performed on the mainland of Tasmania before shipment to either King Island or the Furneaux Group. 4 Name and address of supplier (if different to manufacturer)—The name and address of the supplier if item(s) were purchased from a business other than the manufacturer. If this is the case you must provide a Supplier’s Certificate (manufacturing) form (TAS028) completed by the supplier of the item(s). This is additional to the form provided by the manufacturer. 5 Details of freight paid—If the freight cost is included in a Free into Store (FIS) price, the Manufacturer’s Certificate or Supplier’s Certificate (manufacturing) must also detail the freight component. Note: Supplier and/or manufacturer letters will need to be provided every 2 years or on request. 1 Item 2 Detailed description of use of 3 Name and address of manufacturer 4 Name and address of supplier 5 Details of freight paid item in process (if different to manufacturer) Freight component See note of FIS price 5 above Itemised separately Freight component See note of FIS price 5 above Itemised separately Freight component See note of FIS price 5 above Itemised separately Freight component See note of FIS price 5 above Itemised separately Freight component See note of FIS price 5 above Itemised separately Continue to page 2 TAS026.1810 1 of 2 Privacy notice Returning your form You can return this completed form to: 2 You need to read this Email: [email protected] Privacy and your personal information Post: Department of Human Services Tasmanian Transport Schemes Your personal information is protected by law (including GPO Box 1269 the Privacy Act 1988) and is collected by the Australian Hobart TAS 7001 Government Department of Human Services for the Fax: (03) 6211 2719 assessment and administration of payments and services. This information is required to process your application or claim. For more information Your information may be used by the department, or given Website: www.humanservices.gov.au/tfes to other parties where you have agreed to that, or where it Phone: 131 158 (call charges may apply) is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including our privacy policy, at www.humanservices.gov.au/privacy 3 Manufacturer’s and Miner’s Statement I declare that: • the information I have provided in this form is complete and correct. I understand that: • giving false or misleading information is a serious offence. Printed name Position in organisation Signature Must be an authorised person or signatory as listed on your TFES registration form. Date / / TAS026.1810 2 of 2.