7.

Indicate the reason(s) for the application by ticking the appropriate box below:

(a)

The licensed facility or activity is no longer required

(b)

The licensed facility or activity is not economically justifiable

(c)

Another person is willing and able to assume the rights and obligations of the licensee concerned in accordance with the requirements and objectives of the Act

8.

if the reason for the application is that the licensed facility or activity

(a)

is no longer required, or

(b)

is not economically justifiable,

provide a details explanation and submit documentation in support of your reason(s).

.................................................................................................................................

.................................................................................................................................

.................................................................................................................................

9.

If the reason for the application is that another person is willing and able to assume the rights and obligations of the licensee in accordance with the requirements and objectives of the Act, provide the following information about that person—

(a)

registered name ...................................................................................

(b)

trading name (if different from registered name)

..............................................................................................................

(c)

physical address of the registered place of business

..............................................................................................................

..............................................................................................................

(d)

physical address of the principle place of business (if different from the registered place of business)

..............................................................................................................

..............................................................................................................

(e)

postal address .......................................................................................

(f)

telephone number ................................................................................

(g)

fax number ...........................................................................................

(h)

Email address .......................................................................................

(i)

Contact person at applicant, including:

(j)

submit an undertaking (Section C of this form) by that person confirming its willingness and ability to assume the rights and obligations of the licensee in accordance with the requirements and objectives of the Act and that the person will apply for the relevant licence.

(k)

submit documentary proof of the ability to assume the rights and obligations of the licensee in accordance with the requirements and objectives of the Act.