Health Protection Service Licence or Registration Transfer of Ownership
About this form
This form is to be used to transfer ownership of one of the following licences or registrations under Public Health Act 1997:
- Cooling tower or warm water storage system registration
- Health care facility activity licence
- Infection control activity licence
Instructions for completion and important information
This application form must be completed by both the current licence or registration holder and the new applicant.
To complete this application you will be required to upload copies of certain documents:
- The current licence or registration certificate.
- Individuals: A certified copy of photographic identification.
- Companies: ASIC extract and a certified copy of photographic identification of the agent completing the form.
- Fee exempt registrations: Evidence of fee exemption.
You will be able to upload these documents at the end of the application.
A transfer fee of $79 applies except for the following fee exempt categories:
- Cooling Tower or Warm Water Storage System: Owner or manager of the system to which the registration relates is a charity.
- Infection Control: Owner of the licensed premises to which the licence relates is a charity.
Locked Bag 5005
WESTON CREEK ACT 2611
Payments up to $10,000 can be made with either Visa or MasterCard.
Your personal information
Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.