To the General Manager, CoffsHarbourCity Council
TRANSFER OF LEASE/LICENCE
INFORMATION REQUIRED
Local Government Act 1993, Roads Act 1993, Crown Lands Act 1989
Locked Bag 155, Coffs Harbour 2450;
Administrative Centre, 2 Castle Street, CoffsHarbour
Email: Phone: (02) 6648 4000 Fax: (02) 6648 4199
Website: ABN 79 126 214 487
This form ISNOT an Application Form. The form provides Council with the information required to prepare a transfer of lease / licence. Letters making application for the transfer of lease / licence from both the Transferor and the Transferee must accompany this form. Such letters are to provide full details to enable Council to consider the request. PLEASE COMPLETE ALL SECTIONS.
1. Details of Premises
Name of Premises / Proposed Date of Transfer
Existing Lessee (Transferor)
Solicitor’s Name (if applicable)
Solicitor’stelephone / Fax / Mobile
2. New Lessee (Transferee Details)
Mr Ms Mrs Other:
Given name/s or company name / Surname
ABN / Contact Person
Guarantor’s full name (if Lessee is a Pty Ltd Company)
Lessee’spostal address
Suburb or town / State / Postcode
Lessee’s service address (must be a place of residence or business – not a post office box)
Daytime telephone / Fax / Mobile
Email address
Solicitor’s Name (if applicable)
Solicitor’stelephone / Fax / Mobile
Office Use Only
Date received / Application fee (if applicable) / Receipt No.
3. Insurances / Page 2
Public Liability (minimum $20 million) –
The following parties must be noted on the policy for their respective rights and interests:-
  • CoffsHarbourCity Council.
  • If Crown Land – The Minister Administering the Crown Lands Act 1989 AND the relevant Reserve Trust.
  • If Regional Park – The NSW Office of Environment and Heritage, Parks and Wildlife Group AND Minister Administering the National Parks and Wildlife Act 1974.
Certificate of Currency for Public Liability is to be attached and submitted with this application to Council.
4. Business Credit Referees
Please supply details of two Business Credit Referees:
Written References from these people also to be attached to application.
Referee No. 1 / Referee No. 2
Name: / Name:
Address: / Address:
Telephone (BH) / Telephone (BH)
5. Privacy and personal information protection notice
  • This information is voluntarily required to process your request and will not be used for any other purpose without seeking your consent, or as required by law;
  • your information may comprise part of a public register related to this purpose;
  • your application will be retained in Council’s Records Management System and disposed of in accordance with the Local Government Disposal Authority;
  • your personal information can be accessed and corrected at any time by contacting this Council.

Applicant’s Signature/s
I declare that to the best of my knowledge all particulars supplied by me are correct and completed. I understand that inaccurate or false statements may cause my application to be delayed or rescinded.
Signature/s : …………………………………………………………………………… Date: ……/……./…….

Transfer Lease / Licence Information Required [FRM –E014] 2/12/2014