<p>Application for Temporary Acknowledgement Notice</p><p>This form will allow the transfer of a property with a pool that was installed before 1 January 2003 that has not been certified or notified in specific situations without the requirement to upgrade the enclosure 1 About the person to which premises are being transferred all applicants to provide details Your name Applicant 1 Title Given names Surname</p><p>Applicant 2 Title Given names Surname Your address Residential Postal Your phone number Work Home Mobile 2 Where would you like the Temporary Acknowledgement Notice to be sent? Email Details:</p><p>Agent i.e. conveyancer</p><p>Post</p><p>3 Property details </p><p>This property is: rented owner-occupied</p><p>4 Application *Circle or tick where applicable – NOTE: all owners must sign NORTHERN TERRITORY OF AUSTRALIA Swimming Pool Safety Act – Section 28, Regulation 18 1. *I / We apply for a Temporary Acknowledgement Notice for the premises at: Premises where pool is located: …………………………………………………………………………………………………. 2. *I / We confirm that the swimming pool/spa at the property described in the application was installed prior to 1 January 2003 and does not currently meet either the Community Safety Standard or the modified Australian Standard. 5 Type of small premises</p><p>Please tick the type of small premises to be transferred and include supporting documentation: Premises that are part of the estate of a deceased person and the fee simple interest Death certificate or Probate issued by a court is to be transferred, for no consideration, to a spouse, surviving relative, or member of the deceased person’s family Premises that are part of the property to be transferred in accordance with a Orders issued by a court property settlement under the Family Law Act 1975 (Cth) or the De Facto Relationships Act (NT) Premises in respect of which the fee simple interest is to be transferred to a N/A purchaser who is, immediately before the transfer, a tenant-in-common with the Chief Executive Officer (Housing) under a housing scheme Premises in respect of which there is a transfer of the fee simple interest to an Birth certificate of person to which premises are being immediate family member of the previous registered owner or registered proprietor transferred</p><p>Page 1 of 2 Approved 30 June 2014 Signed: Signed: (Applicant 1) (Applicant 2) ……………………………………………………………… …………………………………………………… 6 How to send the completed form any of the below methods may be used Email Fax Post [email protected] 08 8923 7604 Swimming Pool Fencing Unit GPO Box 1680, Darwin NT 0801</p><p>Please note it takes approximately 5 working days for our office to process applications. </p><p>Page 2 of 2 Approved 30 June 2014</p>