Cl250 annual recording form

To comply with Clause 250 of the Water Management (General) Regulation 2018, this form is to be completed by all water users whose work(s) don’t require a meter to record annual licensed and basic landholder rights (BLR) water take from a licensed work, and to confirm that cease to take conditions do not apply. You are required to report your take even when it is zero.

Please submit a separate form for each work approval. Report to us within 28 days of the end of the water year (30 June).

To satisfy your recording conditions you must keep a copy of this form for your records for up to five years.

You must also keep the following records:

Daily and monthly licensed water take
Record that cease to take conditions do not apply

Daily and monthly licensed water take and record that cease to take conditions do not apply can be recorded using pages 2 – 5 of Cl 250 annual recording form PDF. You do not need to submit pages 2-5 of CI 250 annual recording form to us but must keep a copy for your records for up to five years and have available to show to an authorised officer from the Natural Resources Access Regulator (NRAR) on request.

Recorder's details

Work approval holder name *
Contact phone number *
Email address *
Do you have the authority to submit this form on behalf of the approval holder? *	Yes

Details of work

Water type *	Regulated Unregulated Groundwater
Work approval number * e.g. 50CA000001
Water access licence number * e.g. 50AL000001
Extraction site number e.g. ESID and meter number
Work type e.g. pump, bore, regulator

Recording and reporting

Name of person recording
Year
Total volume of ML taken for the year. If no water has been taken, please put zero usage (0ML)
Volume of ML taken for the year for BLR or other licence exemption

Declaration

I acknowledge and agree to all terms and conditions *

Terms and conditions

False or misleading information

Giving false or misleading information is a serious offence under Part 5A of the Crimes Act 1900. It is an offence under section 91J of the Water Management Act 2000 for a person to make a statement or supply information in or in connection with a metering record required to be kept that the person knows to be false or misleading in a material particular.

Privacy statement

The personal information that is provided in this form will be managed by WaterNSW in accordance with its Privacy Procedure, or other such policy document as updated from time to time. The information provided in this form is being collected and used for purposes relating to the record confirmation of specified matter before water is taken described in this form to the Water Management Act 2000 (NSW). The information choose not to provide the requested information in this form, you may not be able to take water and you may be in breach of the Water Management Act 2000. You have the right to request access to, and correct details of your personal information held by WaterNSW.

WaterNSW acknowledges the traditional custodians of the lands and waters on which we work and pay our respects to all elders past, present and emerging. Learn more