Annual Fire Safety Statement - Request for a Stay of Infringement

This form should be completed where an Annual or Supplementary Fire Safety Statement cannot be submitted by the due date.

Note:

• Please ensure all fields on this form are completed. Incomplete applications are unable to be considered and will be declined.
• If the space in the fields provided is insufficient, please attach additional pages where required.

• An invoice for the associated fee will be sent to you and must be paid within 48 hours. Failure to arrange payment will result in your application being declined, which may result in a penalty infringement notice being issued.