Transfer Registration
Application Form
Please return this form to: or Ashburton District Council, PO Box 94, Ashburton 7740
Applicant Details
Postal Address:
Current Licence Holder
Postal Address:
Name of Premises:
Licence Number:
Business Type:
Licence Transferred To
Phone Number:
Mobile Number:
Date of Birth:
Proposed Trading Name:
Signature and Date
I hereby make an application to transfer my registration.
Signed: _____________________________ Name: _________________________________
Note: This application must be made within 14 days of the change in the occupation of premises. The new occupier
shall complete this form and return with the fee and current certificate of registration. A new certificate of
registration will be issued.
Office Use Only:
Received? Yes No New Licence Number:
Receipt issued Yes No Fee:
click to sign
click to edit
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