Memorandum Of Assignment Of A Mortgage Over Quota Shares (Page 3 of 3) in pdf

Any additional pages must be initialled

Have you attached any additional partial assignment details pages?

by the person signing the form.

Yes

Number of additional partial assignment details pages attached

Mortgagee Declaration

I declare that:

This declaration must be made by the



The information I have given on this application is true and correct.

current mortgagee or authorised signatories



I am aware it is an offence to knowingly provide false or misleading information or omit any

of the current mortgagee.

material information to obtain a benefit under the Fisheries Act 1996.



I have read and understood the Collection of Personal Information details supplied with this

form.



Please complete if you are an authorised

I am authorised to complete this application form and at the date hereof I have not received

any notice or information of the revocation of my authorisation from:

signatory.

If there are more signatories than space

(full legal name of mortgagee)

provided make further declarations on a

copy of this page.

Full Name of Signatory

Position

Signature

Date

General Notes

All information on this application must be typewritten or hand printed in legible letters using ink. Correction fluid may not be used.

The person/s signing this form must initial every page.

All amendments must be initialed by the person/s signing this form.

The current mortgagee or an authorised signatory of the current mortgagee is required to sign this form.

The quota owner and the mortgagees will be notified of the outcome of this application.

This application form is not the contractual documentation between the parties. This form is an application to register the assignment of a

mortgage on the Quota Register.

This Memorandum of Assignment of a Mortgage has no effect for the purpose of the Quota Registers until registered by FishServe.

This Memorandum of Assignment of a Mortgage will be registered in accordance with Section 159 of the Fisheries Act 1996, provided that

the application is properly completed and complies with the Fisheries Act 1996.

This application must be accompanied by the prescribed fee.

The fee for this application can be determined by referring to the Schedule of Fees available from FishServe. Please make cheques

payable to Commercial Fisheries Services Limited.

This fee is inclusive of GST.

Please present this document with the prescribed fee by post to FishServe, PO Box 297, Wellington 6140, or in person to

Level 6, 135

Victoria

Street, Wellington.

If you have any queries regarding this form, please contact the FishServe helpline on (04) 460 9555

Collection of Personal Information

In regard to any information being collected on this form that is personal information, notification is hereby provided, in accordance with

Principle 3 of the Privacy Act 1993 of the following matters:

This information is being collected for the purposes relating to the management of fisheries resources in accordance with the Fisheries Act

1996 and regulations made pursuant to the Act.

The agency that will collect and hold the information is FishServe (PO Box 297, Wellington 6140) .

You are reminded that under Principles 6 and 7 of the Privacy Act 1993, you have the right to access to, and correction of, any personal

information which has been provided to FishServe.

The provision of the information is mandatory for the registration of this memorandum.

You may apply to FishServe to prevent the display of your address on registers kept under the Fisheries Act 1996 where you consider that

disclosure would be prejudicial to your personal safety or to the safety of your family.

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Memorandum Of Assignment Of A Mortgage Over Quota Shares Page 3

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