Name(Required) First Last Company Name(Required) Postal Address(Required) Street Address Town/Suburb Postcode TelephoneMobile Phone(Required)Email(Required) Description of activity to take place on the footpath(Required)For example, information boothLocation on footpath from which activity will take place(Required)Description of vehicle/structure from which activity will take place(Required) Type of Permit(Required) Annual Temporary Dates Permit is Required(Required) Please provide a copy of your Public Liability Insurance Certificate of Currency for $20 million with this application.(Required)Max. file size: 128 MB.Declaration(Required) I declare that all the above information is true and correct and I agree to abide by the conditions of the permit. Furthermore I understand and acknowledge that any fee paid with this application is not refundable should this application be refused.Signature(Required) Reset signature Signature locked. Reset to sign again