Third Party Lobbyist meeting request form

Are you:

• A Third-Party Lobbyist
• An Other Lobbyist

Section 1: PURPOSE

Section 2: MEETING DETAILS

Enter the name of the Officer you want to meet with (If known):

Department Officer's Title

Preferred Date

Estimated Duration (in minutes or hours))

List dates when participants are not available to meet (if applicable)

Preferred meeting location

The Department requires meetings involving third-party lobbyists to be held at a NSW government office, unless otherwise decided by an Executive Director or a more senior executive.

Meetings held at other locations are subject to the Department's approval.

Other location

Section 3: THIRD-PARTY LOBBYIST DETAILS (as described in the Third-Party Lobbyist Contact Register)

Third-Party Lobbyist Organisation (including your name and title)

Client/s represented (for the purpose of this meeting)

Is your client a foreign principal?

If yes, in which foreign country is your client a foreign principal

Section 4: ATTENDEES

LOBBYIST CLIENT ATTENDEE/S (Name and title)

THIRD PARTY LOBBYIST ORGANISATION ATTENDEE/S (Name and title)

BUSINESS CONTACT ATTENDEE/S (Name and title, reason for attendance) (if none, please state n/a)

OTHER ATTENDEE/S (Name and title, reason for attendance) (if none, please state n/a)

Are the above third-party lobbyist(s) and the third-party lobbyist organisation(s) registered on the NSW Register of Third-Party Lobbyists?

• Yes
• No

Section 5: DISCLOSURE OF INTERESTS

Do the third-party lobbyist(s) attending the proposed meeting have a financial or other interest in the matter/s to be discussed?

• Yes
• No

Section 6: LOBBYING ON NSW GOVERNMENT BOARD OR COMMITTEE BUSINESS

Is the business contact(s) listed above a member of a NSW Government Board or Committee?

• Yes
• No

Section 7: CONTACT DETAILS

Name

Title

Email *

Email (Please type again) *

Telephone *

Section 8: DISCLAIMER

Under the Lobbying of Government Officials Act 2011 and the Lobbyists Code of Conduct 2014 , the following ethical standards and requirements apply.

All lobbyists must:

1. disclose in advance any matter that they wish to discuss, when seeking a meeting with a Government official;
2. disclose any financial or other interest they may have in the matter to be discussed before the meeting commences;
3. not engage in any misleading, dishonest, corrupt, or other unlawful conduct in relation to their lobbying; and
4. use all reasonable endeavours to satisfy themselves of the truth and accuracy of all material information that they provide.

In addition, third-party lobbyists, and any individuals that they engage to lobby on their behalf, must:

1. not meet or otherwise communicate with Departmental officials unless registered on the NSW Register of Third-Party Lobbyists;
2. disclose, prior to any meeting or communication with Departmental officials:
   • their status as third-party lobbyists;
   • the names of any individuals they have engaged to undertake lobbying on their behalf; and
   • the name/s of their client/s;
3. not lobby on a matter that relates to a NSW Government board or committee of which they, or the individuals they engage to lobby on their behalf, are a member;
4. not make exaggerated or misleading claims to their clients about the nature or extent of their access to political parties or Government;
5. keep separate from their lobbying activities any personal involvement with a political party; and
6. not receive success fees for lobbying NSW Government officials.

• I confirm that this meeting request complies with all of those requirements. (If YES tick the box.) *