Authorisation to Act – Consent Form

1Owner Details

2Property Details

3Authorisation Details

4Declaration

Consent Form ID

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Full name of Owner(Required)

Title First Last

Contact Number(Required)

Email(Required)

List only the properties affected by this consent.

Properties affected by this consent

Assessment Number	Address	Actions

There are no Properties.

Maximum number of properties reached.

Are there other owners for the properties below?(Required)

Yes

Have all the other owners agreed to this authority to act consent?(Required)

Yes

Name of authorised person(Required)

First Last

Relationship to you(Required)

Please tick all items you are providing authority for(Required)

Make enquiries regarding ALL matters to do with my property

Make payment arrangements on my behalf

Update my contact details

Request refunds/transfers for my property

Applicable forms/information will need to be supplied where required

Consent(Required)

I consent to the below authorisation statement(Required)

I, the owner of the above-mentioned properties, give who is my permission to:

Consent(Required)

I agree that the information provided on this form is true and correct(Required)

Would you like a copy of this application sent to your email?

Yes

Signature

Photo Id(Required)

Please upload a copy of your photo ID.

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.

Submission Date

DD slash MM slash YYYY

Comments

This field is for validation purposes and should be left unchanged.