Building the national Capital in the heart of all australians ABN 75 149 374 427
National Capital Authority | GPO Box373, CanberraACT2601 | www.nationalcapital.gov.au | worksapproval@natcap.gov.au
LETTER OF AUTHORISATION
for applicants to obtain permission from lessee or land custodian to lodge
an applicaon with the Naonal Capital Authority on their behalf.
Block
LEASE/SITE DETAILS (please print)
LESSEE(S)/LAND CUSTODIAN(S) DECLARATION
APPLICANT DECLARATION
If more than one lease/site please aach the following details for each addional lease/site on a separate sheet
If more than two enes please provide details of each addional lessee on a separate sheet
I/we declare that I am/we are the lessee(s) of the land described above;
I/we have been made aware of the proposed works and support the application; and
I/we declare that all the information given on this form is true and complete.
I/we declare that all information given on this form and its attachment is true and correct;
If signing on behalf of an organisation:
I/we the undersigned declare I/we have the appropriate delegation or authority to sign on behalf of the organisation.
Section
Suburb/District
Road Reserve
Address
Name
Title/Position
Telephone Email
Signature Date
Name Organisation Name
Signature Date
Name
Title/Position
Telephone Email
Signature Date
Description
of Works
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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