Online Form - Application for naming of a road or place or addition to the road and place name register

This application form may be used to recognise an existing colloquial road or place name, apply a new name to a currently un-named location, or request the addition of the proposed name to the Road and Place Name Register. Any application must be accompanied by justification of its selection.

Applicant Details

Name*

Postal Address*

Phone*

Mobile*

Email*

Please select the date*

Proposed Name

Proposed Name/s or Theme*

Is the proposed name/s themed or commemorative?*

Is the name an existing colloquial name, or a proposed name?*

Is the name proposed to be a dual name?*

YesNo

Proposed location, if any

Origin / Justification

Please tell us about the origin / justification for the name change*

Please upload any supporting documentation for your application

Maximum size of ALL attachments is 976.56 MB

For Commemorative Naming Only

Upload demonstrated record of achievement

Maximum size of ALL attachments is 976.56 MB

Upload evidence of immediate family consent

Maximum size of ALL attachments is 976.56 MB

Upload evidence of community support

Maximum size of ALL attachments is 976.56 MB