CBF Advisory Committee

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Welcome to the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee Nomination Form. Please complete the following sections to submit your nomination.

I hereby nominate to be a community representative on the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee.

I accept that selection and appointment to the Committee will be subject to CS Energy’s discretion and to me being:

a current local resident, worker or landowner potentially impacted by the project or a member of a stakeholder group with an interest in the project, including an industry, community, environmental or Traditional Owner group.
able to demonstrate my involvement in the local community or community activities.
knowledgeable about the project and its related issues of concern to the local community.
able to represent and communicate the interests of the affected local community.
willing to adhere to the Committee’s code of conduct.
not employed by the proponent/applicant or working as a contractor to the project.

All nominations will be considered in respect to other applicants. A nomination does not mean that the person will necessarily be selected.

Nomination Criteria Information *

Please include information demonstrating how you meet the above criteria.

Signed declaration

If appointed to the Committee, I:

confirm that I am aware of my responsibilities as a community representative on the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee
accept that the position is voluntary with no entitlement to pay
agree to sign and comply with the committee’s Terms of Reference
agree to sign a declaration of interest form and keep this declaration up to date.

Full Name *

First

Last

Email *

Email Address

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date *

Signed Declaration *

Clear Signature

If appointed to the Committee, confirm your awareness of responsibilities.

Declaration of Interest

All members of the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee must complete this declaration of interest form.
Members must disclose any interests before they join the Committee and keep this declaration up to date while they are members of the Committee.
This declaration protects the integrity of the Committee and the reputation of its members.

Examples of an interest may include, but are not limited to:

holding shares in an entity proposing or carrying out a contract with the project
representing a stakeholder group who has received funding or grants from the project
family or personal relationships, or involvement in community, social, or other cultural groups that may include an interest of a financial or non-financial nature.

As a member of the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee, I declare that I have no interest that would prevent me from carrying out my role on the Lotus Creek Wind Farm Community Benefit Fund Advisory Committee impartially and in the best interests of the local and broader community.

Should this change, I agree to update this declaration and advise the Committee accordingly.

Declaration of Interest *

As a member of the Community Benefit Fund Advisory Committee, declare your interests.

Declaration Agreement *

I have read and agreed to the declaration.

Should this change, I agree to update this declaration and advise the committee accordingly.
I understand this declaration, and any subsequent actions that follow this declaration, will be noted in the Committee’s meeting notes, and that the Chair of the Committee may ask me to withdraw from discussion on particular issues.

Agreement Signed of

Downloadable forms

If you would prefer to download and print the forms, please complete both forms liked below and return them via email to JCHAD@csenergy.com.au