To [name of local authority]
Name of submitter: [full name]
This is a submission on the following proposed policy statement (or on the following proposed plan or on a change proposed to the following policy statement or plan or on the following proposed variation to a proposed policy statement or on the following proposed variation to a proposed plan or on the following proposed variation to a change to an existing policy statement or plan) (the proposal):
[name of proposed or existing policy statement or plan and (where applicable) change or variation].
I could/could not* gain an advantage in trade competition through this submission.
*I am/am not† directly affected by an effect of the subject matter of the submission that—
(a)
adversely affects the environment; and
(b)
does not relate to trade competition or the effects of trade competition.
| *Delete entire paragraph if you could not gain an advantage in trade competition through this submission. |
| †Select one. |
The specific provisions of the proposal that my submission relates to are:
[include—
whether you support or oppose the specific provisions or wish to have them amended; and
I seek the following decision from the local authority:
*I wish/do not wish† to be heard in support of my submission.
| *In the case of a submission made on a proposed planning instrument that is subject to a streamlined planning process, you need only indicate whether you wish to be heard if the direction specifies that a hearing will be held. |
| †Select one. |
*If others make a similar submission, I will consider presenting a joint case with them at a hearing.
| *Delete if you would not consider presenting a joint case. |
.
Signature of submitter
(or person authorised to sign
on behalf of submitter)
.
Date
(A signature is not required if you make your submission by electronic means.)
Electronic address for service of submitter:
Telephone:
Postal address (or alternative method of service under section 352 of the Act):
Contact person: [name and designation, if applicable]
Note to person making submission
If you are making a submission to the Environmental Protection Authority, you should use form 16B. If you are a person who could gain an advantage in trade competition through the submission, your right to make a submission may be limited by clause 6(4) of Part 1 of Schedule 1 of the Resource Management Act 1991.
Please note that your submission (or part of your submission) may be struck out if the authority is satisfied that at least 1 of the following applies to the submission (or part of the submission):
it is frivolous or vexatious:
it discloses no reasonable or relevant case:
it would be an abuse of the hearing process to allow the submission (or the part) to be taken further:
it contains offensive language:
it is supported only by material that purports to be independent expert evidence, but has been prepared by a person who is not independent or who does not have sufficient specialised knowledge or skill to give expert advice on the matter.
Schedule 1 form 5 heading: amended, on 18 October 2017, by regulation 15(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2017 (LI 2017/231).
Schedule 1 form 5 heading: amended, on 1 November 2010, by regulation 19(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2010 (SR 2010/279).
Schedule 1 form 5: amended, on 3 September 2020, by regulation 7(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2020 (LI 2020/180).
Schedule 1 form 5: amended, on 18 October 2017, by regulation 15(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2017 (LI 2017/231).
Schedule 1 form 5: amended, on 14 September 2017, by regulation 15(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2017 (LI 2017/231).
Schedule 1 form 5: amended, on 1 November 2010, by regulation 19(1) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2010 (SR 2010/279).
Schedule 1 form 5: amended, on 1 June 2006, by regulation 10(2) of the Resource Management (Forms, Fees, and Procedure) Amendment Regulations 2006 (SR 2006/99).