Please return this form to: email@example.com or Ashburton District Council, PO Box 94, Ashburton 7740
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:
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