Personal Information Request

Applicant Details

I (the applicant)*

First Name Last Name

Company Name (Please complete if applicable)

Phone Number*

Email Address*

of (address)*

Street Address Suburb State Post Code

hereby request that Council provide me with contact details of property holders (described as)

Lot Section DP

Other

For the purpose of

and declare that this information is to be used for no other purpose.

Please Acknowledge*

Date Signed:*

Terms and Conditions can be found here.

NB. Council retains the right to refuse this application

Application Reference