Form 12 - Warrant Of Fitness
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1
2FORM 12
WARRANT OF FITNESS
Section 108, Building Act 2004
The Building
Street Address:
_________________________
WOF Number:
_________________________
Legal
Location of building
_________________________
_________________________
Description:
Within site/block:
Building Name:
_________________________
_________________________
Level/Unit Number:
Current, lawfully
Year first constructed:
_________________________
_________________________
established use:
Contact
The Owner
Only complete if you are making the application on behalf of the Owner.
Owners Name:
_________________________
Contacts Name:
____________________________
Postal Address:
_________________________
Postal Address:
____________________________
_________________________
____________________________
Street Address/
_________________________
Street Address/
____________________________
Registered Office:
_________________________
Registered Office:
____________________________
Contact Person:
_________________________
Contact Person:
____________________________
Landline:
_________________________
Landline:
____________________________
Daytime:
_________________________
Daytime:
____________________________
After Hours:
_________________________
After Hours:
____________________________
Mobile:
Mobile:
_________________________
____________________________
Fax:
Fax:
_________________________
____________________________
Email:
Email:
_________________________
____________________________
Website:
Website:
_________________________
____________________________
Contacts relationship with owner:
___________________________________________________
Provide details
□
Details of authorisation from owner to make application on behalf of the owner attached.
Warrant
Maximum Occupancy: ______________________
Highest fire hazard category: _____________________
The inspection, maintenance, and reporting procedures of the compliance schedule for the above building
have been fully complied with during the 12 months prior to the date stated below.
___________________
Date:
The Compliance Schedule is kept at: __________________________
_________________________________________
___________________________________________
Full Name
Signature of owner / agent
FORM12 – V3 – 23/10/2014
Page 1 of 2
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Parent category: Financial