Additions / Changes:

Item 2

AGENT   *(Where the Agent trades as a corporation, include the corporation’s licence number)

Name: ...........................................................................................................................................

Address: …………………………………………………………………….....…  ACN: …………………………

……………………………………………………………………………………...  ABN: …………………………

Phone: ..(….)……………………….. Fax: ..(…..)…………………….…. Mobile: ……………………………..

Email: ………………………………………….…………………………………………..………………………...

Licence Number/s*: ….…………………………………………………...…. GST Registered: __ Yes  __No

Item 3

Smoke Alarms are / are not installed in accordance with Part 9, Division 7A of the Environmental Planning and Assessment Regulation 2000.

(a) smoke alarms last tested and cleaned: …../…../……  (b) Date batteries last changed: …../…../……

{Owners of all houses and units dwellings in NSW must install and maintain smoke alarms in compliance with the Environmental Planning and Assessment Regulation 2000 as amended}

An Electrical Safety Power Switch is / is not installed for general purpose socket outlets.

Additions / Changes:

Item 3

Smoke Alarms are/ are not installed in accordance with Part 9, Division 7A of the Environmental Planning and Assessment Regulation 2000.

Additions / Changes:

Item 3

Smoke Alarms: ..................................................................