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.

Required documents

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.

Please see identification requirements for important information about these documents.

Fee

A transfer fee of $73 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.

Contact

Health Protection Service

Locked Bag 5005
WESTON CREEK  ACT  2611

Email: hps@act.gov.au
Phone: (02) 6205 1700

Payment options

Visa and MasterCard logos

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.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.