e-form

Form C - Application For A Cancellation, Reduction, Waivers And/Or Postponement Of A Registered Charge

Issue date

ID Card No

Title

Name

Surname

Door Name

Door Number

Building Entry Point Name

Street Name

Locality Name

Post Code

Mobile

E-mail

(For Office use)
LRC Number:
Date:
Payment:
Received by:

Form C

Application For Reference Of Charge

Application Affecting:

Nature Of The Application

List Of Documents Submitted With This Application:

Declaration Of Applicant:

I hereunder signed, declare that all that is stated in this Form A and as far as I know is true, and that I have verified the relative documents, and that there is no fact that I know of that is contrary to that brought in the documents.

Signature and name in block letters