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Application for a new or renewal NSW driller’s licence | 190424 | Page 1 of 5
Application for a new or renewal NSW driller’s licence
Under Section 118A (3A) of the Water Act 1912.
Section A: Applicant details
Title (Mr, Mrs, Ms) Surname Given name(s)
Residential address
Suburb State Postcode
Postal address
Suburb State Postcode
Phone Alternate phone Email
Section B: Employer or trading company information
Company/corporation name (if applicable)
ACN (if applicable) ABN (if applicable)
Postal address
Suburb State Postcode
Phone Alternate phone Email
Section C: Other state driller’s licences
Do you hold a driller’s licence from a State other than NSW?
No Yes – provide details below:
State Class Licence number Expiry date
Section D: Class of licence
New NSW driller’s licence.
Renew NSW driller’s licence. Please provide details:
Current licence class
Current licence number Date of expiry
Change to current NSW driller’s licence (including class and endorsements). Please provide details:
Current licence class
Current licence number
Clear form
Print
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Application for a new or renewal NSW driller’s licence | 190424 | Page 2 of 5
Select appropriate NSW licence class:
NSW licence class NSW licence class description
1 Licence that allows construction of water level and water quality monitoring bores.
2
Licence that allows construction of sub-artesian stock and domestic supply bores up to152 mm
nominal bore casing.
3
Licence that allows the activities of a class 2 licence and also allows the construction of sub-
artesian, screened and developed bores (with open hole, slotted casing, or screen completion
methods, including the use of a formation stabiliser, but not including gravel lter envelope
completion techniques).
4
Licence that allows activities of a class 3 licence and also allows the use of gravel lter
envelope completion techniques.
5
Licence that allows activities of a class 2 licence and also allows the construction of owing and
non-owing bores that penetrate the sandstone aquifers of the Great Artesian Basin and the
construction of owing bores elsewhere in NSW.
6 Licence that allows activities of both a class 4 licence and a class 5 licence.
Section E: Type of endorsement applied for*
Select all applicable:
Auger Jetting Cable tool Rotary air Rotary mud Other methods – Please specify:
*Note: Change of class or endorsement additions to your current driller’s licence will require a fee.
Section F: Statement of equipment capability
Describe the drilling equipment you currently use. Attach extra pages if necessary.
Drilling equipment Make Model Type date Capacity
Drilling rig
Mud pump
Air compressor
Pump test unit
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Application for a new or renewal NSW driller’s licence | 190424 | Page 3 of 5
Section G: Qualications and training of applicant
Please attach proof of completion of the following:
Relevant Australian Drilling Industry Association (ADIA) module.
ADI
A screens and gravel pack course.
NSW Module A.
Interstate driller’s licence.
Other – provide details of other qualications or training information relevant to this application.
Please list the bores constructed in the last three years:
Number of bores drilled
Constructed by me as a licensed driller in: Class 1* Class 2* Class 3* Class 4* Class 5*
• New South Wales
• Elsewhere
Upon which I worked as an assistant to a licensed driller in:
• New South Wales
• Elsewhere
*Refer to licence class descriptions on page 2 of this form.
New drillers who cannot provide evidence of previous drilling experience (Bore construction report –
Form A) will need to provide a reference, on company letterhead, from a licensed driller that shows that
you have been supervised in drilling works including drill rigs and endorsements.
Please supply summary details of the bores you have constructed or worked on in NSW or elsewhere in the last three
years. Attach copies of at least six ‘Bore construction report – Form A’ or interstate completion reports (bore log) for
these bores.
Landholder’s name and address
Bore licence
number
Type of bore*
See note below
Diameter of
casing (mm)
Supply obtained
(litres/sec)
*Type of bore drilled:
• 1 for Water level and water quality monitoring
• 2 for Stock and domestic
• 3 for High yield bores
• 4 for High yield bores incorporating gravel lter envelope
• 5 for Artesian
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Application for a new or renewal NSW driller’s licence | 190424 | Page 4 of 5
Section H: Other information
Please provide any other information below that is relevant to this application:
Section I: Application checklist
Before submitting this form to WaterNSW, please check the following:
The application is fully complete.
The applicant and witness have signed the applicant declaration (Section J and K).
If this is a new licence application, six ‘Bore construction report – Form A’ or interstate completion reports are
attached.
If you are currently unlicensed, please attach references from licensed driller/s (on business letterhead).
Attached copies of relevant training certicates (Section G).
Completed and attached the NSW Module A examination.
Fee included.
Passport sized photograph of the applicant, with name on the back.
If all above requirements are not met, the application will be declined.
Section J: Declaration
I have read Sections 112 and 118A (1) to (7) of the Water Act 1912.
I declare that the contents of this application are true, correct and complete.
I understand it is my responsibility to only drill bores which have a valid licence or approval from WaterNSW.
All bores I have constructed under my current licence have been approved by the relevant authority and
been constructed under my class and endorsement/s restrictions.
I have read the question and answer document on compliance powers, offences, and penalties available on
the WaterNSW website at waternsw.com.au.
I understand that I will be licensed for a period of three years only from the date of issue of this licence and I
must be on site for all drilling operations. I acknowledge that if I wish to continue to be licensed, I am required
to reapply for a NSW driller’s licence before my licence has expired.
Signature Date (DD/MM/YYYY)
/ /
Section K: Witness declaration
I certify that the applicant, whose signature appears above, has signed in the signature box in my presence.
Signature Date (DD/MM/YYYY)
/ /
Name and type of witness (Authorised witness e.g. Justice of the Peace, Notary, Public or Commissioner for Afdavits)
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Application for a new or renewal NSW driller’s licence | 190424 | Page 5 of 5
Section L: Privacy statement
The personal information you provide on this form will be used and protected in accordance with the WaterNSW
Privacy Policy. The information is being collected by WaterNSW and will be used for purposes related to assessing and
Processing your application, or in connection with the operation of any approval granted, or for research-related
purposes such as customer surveys. It may be used from time to time to contact you about services WaterNSW provides.
WaterNSW will not disclose your personal information unless authorised by law. The provision of this information is
voluntary. However, if you choose not to provide the requested information, we will not be able to process your
application. You have the right to request access to, and correct details of, your personal information held by the
department. Further information regarding privacy can be obtained from the WaterNSW website at waternsw.com.au
Section M: Payment of application fee
Application fees are available from the WaterNSW website at waternsw.com.au.
Please nd attached the application fee for:
NSW driller’s licence.
Change to licence (class or endorsements), within current licence period.
Specify method of payment for application fee
Credit card Money order/cheque (made payable to WaterNSW)
(If you select credit card, WaterNSW will contact you on the number below to arrange payment. Please do not
provide your credit card details here.)
Contact for payment
Contact name
Contact number
If an application has been accepted by WaterNSW, payment has been processed and a receipt has been issued,
application fees will not be refunded.
Section N: Submit your application
Send the completed application form, payment, passport sized photograph and other relevant attachments to:
Via email: [email protected]
Via post:
WaterNSW
Driller’s Licensing
PO Box 398
PARRAMATTA NSW 2124
For more information
If you have any enquiries in relation to this application, please contact WaterNSW on 1300 662 077 Monday to Friday
8am - 5pm or email [email protected]
