Notice of Surrender v1.0 12032020
Notice of Surrender
Property and Stock Agents Act 2002
The purpose of this form is for the licence holder to surrender their licence or certificate of registration if it is no longer
required. The form must be completed by the individual licence holder or a director of the licensed corporation.
Name of Certificate or Licence Holder (BLOCK LETTERS):
Certificate or Licence Number:
Declaration
I hereby surrender the above-specified certificate of registration or licence to NSW Fair Trading and have destroyed the
licence or certificate of registration.
In doing so, I acknowledge that once the certificate of registration or licence has been surrendered, the register will be
updated, and it cannot be reinstated. I understand that if there is a need to apply for the same certificate of registration
or licence again in the future, the eligibility criteria that is current at the time the application is made will need to be
met.
I also acknowledge that a partial refund may be applicable where there is more than 12 months duration left on the
certificate of registration or licence. A refund is not applicable for durations of 12 months or less.
If NSW Fair Trading needs to contact me about this application, my contact details are:
Telephone Number: Email address:
Applicant Full Name:
Applicant Signature:
This must be signed by the individual lodging and certifying the above declaration Date:
Lodgement
This form and supporting documentation can be lodged via email to: propertylicensing@customerservice.nsw.gov.au
Enquiries: call NSW Fair Trading on 13 32 20
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signature
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