Regulation 77 Application

Fields marked with * are required
Assisted service details
1. In what capacity are you completing this form?*
  
  On behalf of myself
  
  Agent
  
  Architect
  
  Building Contractor
  
  Other
Applicant
1. Title*
  For example: Mr, Mrs, Miss, Ms, Dr
2. First Name*
3. Surname*
4. Do you have an email?*
  
  Yes
  
  No
5. Email Address
6. Contact telephone number*
7. Please enter your address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
8. Postcode:
10. Address:
11. Company (where applicable):
12. Address 1*
13. Address 2
14. Town*
15. Postcode*
Agent / Contractor Contact Details
1. Name of Agent / Contractor (Business Name)
2. Address of Agent/Contractor
3. First Name (of contact)
4. Surname (of contact)
5. Contact Telephone Number
6. Contact Email Address

Last updated: 22/01/2024 12:22:50