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

For Commemorative Naming Only

Upload demonstrated record of achievement

Upload evidence of immediate family consent

Upload evidence of community support