Indemnity grant request form

In completing this form, please be succinct, but provide sufficient information to enable the Finance Minister to understand the issues and probable cost involved.

1. Brief description of the proposed arrangement and contingent liability.

   
   _____________________________________________________________________________________________________
    

2. Explanation of why the arrangement requires agreement from the Finance Minister.

   
   _____________________________________________________________________________________________________
    

3. Name of the relevant outcome and program (if applicable).

   
   _____________________________________________________________________________________________________
    

4. Date by which agreement is required and reason.

   
   _____________________________________________________________________________________________________
    

5. Term of agreement (including detail on options for extension) including specific term of all contingent liabilities.

   
   _____________________________________________________________________________________________________
    

6. Attach a copy of the risk assessment
   ^{(If complex, please provide a summary. However, you will need to have a comprehensive risk assessment in place for your own records.)}  
   1. Has a risk management plan been established?  Yes / No
   2. Is there a liability cap in place?  Yes / No
   3. What is the most probable total cost of all contingent liabilities? _____________ ($)
   4. Is the most probable cost that might be payable under any contingent liability significant^(*)?  Yes / No
   5. Is the likelihood of the contingencies occurring remote^(#)?  Yes / No
   6. Is there a guarantee for the payment of any amount of principal or interest due on a loan?  Yes / No
   7. Is there an indemnity by the Commonwealth to expressly meet the costs of civil or criminal penalties of the indemnified party?  Yes / No
       
7. Has legal advice been obtained in relation to the contingent liability?  Yes / No

Please attach a copy of the legal advice.
 

^{*significant and #remote: as defined in the Finance Minister’s Delegation to Accountable Authorities.}