Submission coversheet
Application for revocation of coverage of the Dawson Valley Pipeline under the NGL
Please complete and submit this form along with your submission.
1. By email to:	AND	2. In hard copy to:	
gas@ncc.gov.au		Dawson Valley Pipeline
National Competition Council
GPO Box 250
Melbourne  VIC  3001	
			
Individual/Organisation/Company:		
Email address:		
Address:		
Suburb/town:	                   State:                      		              Postcode:	
Principal contact:		
Position/title:		
Telephone:		
	Declaration
To the best of my knowledge and belief: the information provided in the submission is true, correct and complete; complete copies of supporting materials or evidence have been provided and/or clearly identified; all estimates are identified as such and are the best estimates of the underlying facts and; all the opinions expressed are sincere.
			
Signature of authorised person		Office held/title/position	
		  	
(Print) Name of authorised person		Date	
Note:  If the submitting party is a corporation or organisation, state the position occupied in the corporation by the person signing. If signed by a solicitor on behalf of the submitting party, this fact must be stated.
	Please indicate if your submission:-
	contains NO confidential material	
	contains SOME confidential material (in which case please provide two copies of the submission – one with all of the confidential information removed and this