Regulation 77 Application Fields marked with * are required Assisted service details In what capacity are you completing this form?* On behalf of myself Agent Architect Building Contractor Other Applicant Title* For example: Mr, Mrs, Miss, Ms, Dr First Name* Surname* Do you have an email?* Yes No Email Address Contact telephone number* Please enter your address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address Postcode: Address: Company (where applicable): Address 1* Address 2 Town* Postcode* Agent / Contractor Contact Details Name of Agent / Contractor (Business Name) Address of Agent/Contractor First Name (of contact) Surname (of contact) Contact Telephone Number Contact Email Address Next Page Last updated: 22/01/2024 12:22:50