Approved form AF2002-249

Approved by the General Manager of the Health Protection Service on 6.12.2002 under the

Public Health Act 1997, s137A

Public Health Act 1997—Form BH2
(see s31)
Australian Capital Territory

Boarding House Activity Licence

(See attached Boarding House Activity Licence)

Boarding House Licence
«Trading_Name»
ABN: «Proprietor_ABN»
«Premises_PropertyName»
«Premises_StreetNo» «Premises_Street»
«Premises_Suburb»  «Premises_Postcode»
Registration No: «Registration_Number»
This licence authorises «Proprietor_FullName» to carry on a Boarding House at the premises mentioned above for the period starting from {{Date_Granted}} to «Due_for_Renewal».
Standard Conditions
1.	This licence is in force for a single calender year, unless suspended, surrendered or cancelled, or the above mentioned licensee ceases to be the occupier of the premises.
2.	The licensee must inform Health Protection Service of any amendment to the details above within seven (7) days of the change.
Special Conditions
«Conditions»

<Signatory>