New M5 – Heritage salvageRegistration form | 2017

1800 660 248   |    heritage@westconnex.com.au    |   westconnex.com.au

Applicant name

Delivery address

Phone number Mobile number

Email address

Please specify property address for preference determination (if different from above).* You are required to attach a copy

of a recent rates notice to evidence ownership of this property.

Did you own residential property which was acquired for the WestConnex New M5?

Yes No

Should you wish to register for more items, please attach an additional list. There is no need to repeat your details if you are sending multiple forms together.

Package ID(from catalogue)

Item description Package ID(from catalogue)

Item description Package ID(from catalogue)

Item description

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New M5 – Heritage salvage

Preferred delivery time

Please nominate three preferred delivery times. Our delivery contractor will liaise with you to arrange delivery at asuitable time. Deliveries will commence from late July 2017.

Day 7am - 9am 9am - 1pm 1pm - 5pm 5pm - 7pm 8am - 12pm 12pm - 4pm

Monday X XTuesday X XWednesday X XThursday X XFriday X XSaturday X X X XAccess constraints(e.g. parking restrictions / steep slopes / narrow driveway etc.)

Proposed laydown area at property(e.g. front garden / back garden / kerbside / garage etc.)

I, the applicant, have read and understood the information provided in this registration form and acknowledge that this is a lottery process and this application does not guarantee receipt of any items nominated in this form. I understand that if successful, I will be contacted by a representative from WestConnex to agree a time for delivery of the items secured.

I acknowledge and agree to the following:

• That the WestConnex project will take no responsibility for the current or future condition or the suitability for any use of the item or the materials contained in the item;

• That due to the heritage nature of the item it may contain lead paint or other hazardous material;

• That no items may be returned once received;

• That I will not onsell the item;

• Any deliveries to outside the Sydney Metro area will be at my own cost;

• The collection and use of my personal information in accordance with the Privacy and Personal Information Protection Act 1998 (NSW) for the purposes of the New M5 Heritage Salvage process;

I agree to the extent permitted by law, to release Sydney Motorway Corporation Pty Ltd, RMS and their related parties (including WCX M5 PT Pty Ltd and WCX M5 AT Pty Ltd), officers, employees and contractors from any claims arising in relation to the delivery, storage, installation, repair and use of any item or material that is received by me under the New M5 Heritage Salvage process.

Signature of applicant Date

The registration and lottery process will be independently managed by O’Connor Marsden & Associates.Please send completed registration form and supporting documentation to:O’Connor Marsden & Associates New M5 Heritage, Locked Bag 3002, Australia Square NSW 1215

We recommend items are inspected by a qualified person or organisation prior to installation and use.

We speak your languageTo learn more, visit westconnex.com.au. Need an interpreter? Call the Translating and Interpreting Service on 131 450.