Online Form - Application for Registration of a Lodging House

Details

Name of Business Owner

Postal Address of Business Owner

Address of proposed lodging house*

Name of Lodging House

Description of Lodging House

How many storeys is the lodging house?

Number of Rooms for Lodgers

Number of Bedrooms

Number of Dining Rooms

Number of Kitchens

Number of Sitting Rooms

Other (Please specify)

Lodging Classification

Lodging House to be classified as:

Number of Rooms for Private Use

Number of Laundries / Toilets / Bathrooms

Number of Bedrooms

Number of Dining Rooms

Number of Kitchens

Number of Sitting Rooms

Other (Please specify)

Area of Rooms for Private Use

Please specify approximate square meters of area

Area of Laundries / Toilets / Bathrooms

Area of Bedrooms

Area of Dining Rooms

Area of Kitchens

Area of Sitting Rooms

Area of Other (please specify)

Area of Rooms for Lodgers

please enter the approximate square metres of each area

Area of Bedrooms

Area of Dining Rooms

Area of Kitchens

Area of Sitting Rooms

Other (Please specify)

Sanitary Conveniences for Male Lodgers

Please enter the number of sanitary conveniences for male lodgers

Number of Toilets

Number of Urinals

Number of Baths

Number of Showers

Number of Hand Basins

Sanitary Conveniences for Female Lodgers

Number of Toilets

Number of Baths

Number of Showers

Number of Wash Hand Basins

Laundry Facilities

Number of Coppers

Number of Washtroughs

Number of Washing Machines

Number of Drying Cabinets

Number of Clothes Lines

Additional Details

Lodgers' meals will be provided by:

Will the keeper reside continuously on the premises?

YesNo

Please specify the name and occupation of the proposed manager if keeper elsewhere:

How many family members will reside on the premises with the keeper / manager?

Declaration

I/We declare that all details in this form are true and correct. Please be advised providing false information may be an offense.

An Application / registration fee of $250 is applicable to this application.

Name of Applicant

Contact Number

Signature of Applicant

Date