Single Use Plastics - Exemption form

1

Please note:

This form will take approximately 20 minutes to complete.

The form can be saved part way through and completed later.

Multiple exemption reasons and/or items can be captured through the one application. Please clearly explain the reason that relates to each item.

Running down excess stock is not a valid reason for an application.

Please contact plastic-exemptions@dwer.wa.gov.au if applying for Stage 1 items.

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Applicant type* This field is required.Please select an option.

Individual (e.g. sole trader)

Company

Local Government Authority (LGA)

State Government Authority

Other (if other do not complete this form - please email plastic-exemptions@dwer.wa.gov.au or call 6364 7000 and ask for the single-use plastics team).

3

You have selected State Government Authority (SGA). Please indicate which SGA is applying.

4

You have selected Local Government Authority (LGA) as the applicant type. Please indicate which LGA is applying.e.g. Shire of/ City of etc.

5

What type of exemption are you applying for?* This field is required.Please select a type of exemption.

Unavoidable supply chain issues

Public health consideration

Disability support

Transitional supply

Public and workplace safety and security

Policy objective in government relating to waste

Other (if other please call 6364 7000 or email plastic-exemptions@dwer.wa.gov.au)

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This is an application for an exemption relating to a banned* This field is required.Select one or multiple items.

Plastic food container

Plastic tray

Plastic lid for bowl, plate, food container, or tray

Degradable plastic Item

Expanded plastic packaging

Microbead product

Plastic hot beverage cup

Other (if other do not complete form - please email plastic-exemptions@dwer.wa.gov.au or call 6364 7000 and ask for the single-use plastics team

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Please list the products you are applying forInclude the grammage, composition (including inks, dyes, and adhesives), volume, product number (SKU), expected quantity, and manufacturer or supplier information. Please use headings for different products.

8

Please upload any relevant information relating to the products you are applying for

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Max. file size: 10.6MB

9

Please upload photos of the product(s) you are applying to have an exemption forPlease use 'small' photo size or condense photos.

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Max. file size: 10.6MB

10

Please consider the the examples below when answering the next question

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Summary of reason for seeking an exemption* This field is required.

0/500

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What date is the exemption requested until?* This field is required.Please choose a date.

Date

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Business or Individual details* This field is required.

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Authorised representative details* This field is required.Please note this is who the department will contact in relation to this application.

15

Authorisation to act as representative of the occupierFor company/business applications: A copy of the documentation authorising the applicant to act on the company’s behalf as their authorised agent/representative must be provided.

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Max. file size: 10.6MB

16

Registered business addressPlease write your registered business address - as appears on your ASIC extract.

17

ASIC company extractPlease upload a copy of your ASIC company extract if available.

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Max. file size: 10.6MB

18

Supporting informationPlease upload any relevant supporting information such as product information or business case.

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Max. file size: 10.6MB

19

Supplier evidence of supply chain issuesPlease attach evidence of supply chain issues from your supplier.

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Max. file size: 10.6MB

20

Phase-out planPlease attach your phase out plan here.

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Max. file size: 10.6MB

21

Evidence of European certification (if relevant to exemption type)Please attach evidence of EU certification here.

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Max. file size: 10.6MB

22

Evidence of submitted application for to Australian Bioplastics Association (ABA) (if relevant to application type/exemption type)

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Max. file size: 10.6MB

23

I consent to all written correspondence between myself (the applicant) and DWER, regarding the subject of this application being provided via email using the address I have provided.

YESNO

24

Commercially sensitive or confidential informationAll information which you consider is exempt from public disclosure must be separately placed in a redacted version of the application form and its supporting documentation. Grounds for claiming exemption from public disclosure in accordance with Schedule 1 of the Freedom of Information Act 1992 must be specified in an attachment.

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Max. file size: 10.6MB

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Signature* This field is required.Please note that a decision may be made without the request for further information as per r. 21(1) of the Environmental Protection (Prohibited Plastics and Balloons) Regulations 2018. By signing you ensure all relevant documents are complete and truthful at the time of submission.

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Questions?Please type any questions you have regarding your application here.

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Please verify that you are human* This field is required.