/Registration Form/

. / Please fill in the

details below and submit to your Local Authority.
.
/Basic Details/
/Ven/

/Mr/
/Mrs/
/Miss/

/Other/

/If Other, please specify/

,
/Full Name/*

.../NIC/. . *
/Suggestions for Username/
1/Suggestion 1/ 1
2/Suggestion 2/ 2
/Postal Address/ *

/Email address/ *
. ()/ Tel (Residence)/

. ()/Tel (Mobile)/ *

 /Additional Information/
/D.O.B/

/ Passport No/

/Driving License No/

?/Do you wish to have mobile alerts?

/Yes/

/No/

?/Do you wish to have email alerts?

/Yes/

/No/

/Property Details

/Property
ID/

/
Sub Office/

/
Ward/

/Signature of Applicant/

/Road/

/GN/

..
/Date/