(Address to which documents or correspondence in connection with the application can be posted or delivered)
PhoneNumber(s):
Home: Work:
Mobile:
Email Address:
NOTE: Where email addresses are given these may be used as a means of notice and service.
(Address to which documents or correspondence in connection with the application can be posted or delivered)
PhoneNumber(s):
Home: Work:
Mobile: Fax:
Email Address:
NOTICE OF CONSENT
I hereby confirm as follows that: (Please tick the statement that applies )
I do not have any criminal convictions for dishonesty or any other offences that may disqualify me from being a
trustee;
I do not have any civil or criminal proceedings pending before any Court;
I am not currently...
(Address to which documents or correspondence in connection with the application can be posted or delivered)
Email address ................................................................................................................................................................................................................................................................................................
Phonenumbers
Home: ......................................................
(Address to which documents or correspondence in connection with the application can be posted or delivered)
PhoneNumber(s):
Home: Work:
Mobile:
Email Address:
NOTE: Where email addresses are given these may be used as a means of notice and service.
(Address to which documents or correspondence in connection with the application can be posted or delivered)
PhoneNumber(s):
Home: Work: Mobile:
Email Address:
NOTE: Where email addresses are given these may be used as a means of notice and service.
(Address to which documents or correspondence in connection with the application can be posted or delivered)
PHONENUMBER(S):
Home: Work:
Mobile:
Email Address:
NOTE: Where email addresses are given these may be used as a means of notice and service.
Page 1 MLC 04/26 - 5
The Māori Land Court of New Zealand / The Māori Appellate Court of New Zealand
(Please select the name of the Māori Land Court District in which the application was lodged)
Please select one District Taitokerau Waikato-Maniapoto Waiariki
Tairāwhiti Tākitimu Aotea Te Waipounamu
APPLICATION NUMBER: ...........................................................................................................................................................................
I am/We are* the owner/owners* of the block named above and hold [number of shares] _____________shares
out of a total of [total number of shares] _______________ shares in that block.
(Address to which documents or correspondence in connection with the application can be posted or delivered)
PHONENUMBER(S):
Home: Work:
Mobile:
Email Address:
NOTES:
1.