Northern Adelaide Irrigation Scheme Water delivery contract registration of interest Version:1.0 Date: 16/3/2018
1 Declaration I am authorised to submit this Registration of Interest for a NAIS water delivery contract on behalf of the proponent. I acknowledge that this Registration of Interest is solely for the purpose of advising of the proponent s interest in NAIS water. It does not create any legal entitlement to NAIS water now or in the future, and it does not impose any obligation on to offer NAIS water to the proponent. Full Name Position in Enterprise Signature Date Privacy Statement The Government of South Australia is committed to protecting the privacy of your information. In 1989, the Government of South Australia issued a set of Information Privacy Principles (reissued 30 July 1992 and 18 May 2009, 4 February 2013, 5 August 2013, 16 September 2013, and 20 June 2016) to regulate the way personal information can be collected, used, stored and disclosed. Version 0.1 16/3/2018 Page 2 of 9
2 Contact details 2.1 Business identity and legal status Trading Name Legal Entity Name Australian Business Number (ABN) Australian Company Number (ACN) 2.2 Physical address Number and Street Suburb or Town State or Territory Postcode 2.3 Postal address Number and Street/PO Box Suburb or Town State, Territory, or Province Postcode or ZIP Country Version 0.1 16/3/2018 Page 3 of 9
2.4 Nominated contact Title First Name Last Name Position Phone Email Version 0.1 16/3/2018 Page 4 of 9
3 Business and project description 3.1 Business description Please provide a description of your business, including business history and current business activities. Please highlight any prior involvement in agribusiness. 3.2 Business presence in South Australia Please indicate the nature of your proposed business presence in South Australia e.g., head office, national office, branch office, project office, site office, etc. 3.3 Project location and land tenure status Please attach a map or plan showing the proposed geographical location of the project, adjacent roads, and the extent of land holdings proposed. Please indicate the proposed water offtake point or points. What is your current right of tenure over this land? Version 0.1 16/3/2018 Page 5 of 9
3.4 Project description Please describe the project for which you will use NAIS water, including: products producti on technologies, systems, and methods local, national, and international markets (either existing or proposed) for the proposed products channels and supply chains to market significant channel partners, in-market partners, and cornerstone customers 3.5 Project feasibility Please explain what will make the project feasible, including: product and market research value proposition and competitive advantages staff with relevant experience and skills confirmed funding Version 0.1 16/3/2018 Page 6 of 9
3.6 Economic impact Please provide information about the new additional investment, export earnings, and employment outcomes expected from the proposed project. 3.7 Special requirements Please advise any special requirements attaching to the project. Version 0.1 16/3/2018 Page 7 of 9
4 Project implementation and water requirements 4.1 Construction, operation, and growth Please set out key stages and timelines in the construction, operation, and growth of the project, through to peak production. Please add to the table if more rows are required. Stage Key milestones Commencement date Completion date Total water (ML) 4.2 Water quality requirements What specific water quality requirements do you have? e.g. salinity, ph, nutrients etc. Version 0.1 16/3/2018 Page 8 of 9
4.3 Additional attachments Please attach other relevant documents that can provide additional detail about the proposed project. These could include: detailed business plan project plan product and market research product and market strategy technical reports supporting letters from channel partners, in-market partners, and cornerstone customers evidence of equity and debt funding projected profit and loss statements maps Version 0.1 16/3/2018 Page 9 of 9