Bin Trim Registration Form

Bin Trim Registration Form

Please fill in the your details
Business Name*
ABN
Address of the premises*
Street Address
Suburb*
Suburb
Postcode*
Post Code
Contact Name*

First NameLast Name
Position*
Phone*
Email*
Website

REGISTRATION FORM

NSW EPA is delivering the Bin Trim Networks Program. Bin Trim assessors will provide businesses in targeted sectors or locations with free waste assessments and support to reduce their waste.

Name:	{contactName}
Position:	{position}
Date:	{date}

Grantee name:	ENERGY CONSERVATION
Assessor name:	Sam Quirk
Business name:	{typeA}
ABN:	{abn}
Address of premises:	{addressOf12}/{typeA14}, {suburb}, NSW, {postcode}
Phone:	{phone}
Email:	{email}
Website:	{website}

Required:

✓ I agree to participate in the Bin Trim program, with Energy Conservation.

✓ I understand that Energy Conservation will conduct an initial and follow up assessment and provide me with a Waste action plan.

Optional:

□ I agree to Energy Conservation contacting my waste and recycling service provider on my behalf to obtain quotes and information about recycling services.

□ I agree to my contact details being given to my local Council for possible follow up support.

□ I would like to publicly list this site as part of the Bin Trim community. By publicly listing this site, the location address and business name will be displayed on the EPA website and on the Bin Trim community map. Your customers and clients will be able to look you up as a business that is serious about reducing waste. You will need to complete 2 assessments before your site is publicly listed.

□ I would like to receive updates about Bin Trim and business recycling opportunities from the EPA.

Signature*

Clear
Privacy Statement
The NSW Environment Protection Authority (EPA) collects and manages the personal information you provide according to the Privacy and Personal Information Protection Act 1998. Providing your personal information is voluntary; however, the EPA may not be able to process your Bin Trim assessment without it. This information will only be used in connection with the Bin Trim program. It will be entered into the EPA’s Bin Trim App and will be kept confidential at all times. The details will only be accessible by the EPA, its auditors/ sub-contractors, the local Council if you have ticked this box and the grantee (listed above) who has taken these details. Your information will not be accessed or used by any other person or for any other purpose, unless legally required or authorised. Once the EPA has collected your personal information, you have the right to access and correct any of it at any time. To
do this, contact the EPA Business Unit on 131 500 or email Bin.Trim@epa.nsw.gov.au. For privacy enquiries or general enquiries concerning access to or amendment of personal information held by the EPA, call a Right to Information/Privacy Officer on 131 555/ (02) 9995 5555.

These forms must be kept and produced if requested by the EPA or their auditors.
EPA 2021P2768
May 2020 (Update September 2023)
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