FM8012-Form 2 - Assignor's disclosure statement

Form 2 - Assignor's disclosure statement

under section 45A of Retail and Commercial Leases Act 1995
1. Details of lessor
Name of lessor
Address
Street 1
Street 2
Suburb
State
Postcode
Contact details
Work phone number
Home phone number
Mobile phone number
Fax number
Email
2. Details of shop for which lease is to be assigned
Name
Address
Street 1
Street 2
Suburb
State
Postcode
3. Lessor's disclosure statement
Lessor's disclosure statement

The assignor has not provided the assignee with a copy of the lessor's disclosure statement in respect of the lease, together with details of any changes to the information contained in the disclosure statement since the statement was given.The assignor has provided the assignee with a copy of the lessor's disclosure statement in respect of the lease, together with details of any changes to the information contained in the disclosure statement since the statement was given.
4. Outstanding notices in respect of lease
Outstanding notices in respect of lease

There are no outstanding notices in respect of the lease.There are the following outstanding notices in respect of the lease
Name of person giving notice
Date of Notice

DayMonthYear
Details of notice

0/190
5. Outstanding notices from any authority in respect of shop
Outstanding notices from any authority in respect of shop

There are no outstanding notices from any authority in respect of the retail shopThere are the following outstanding notices from an authority in respect of the retail shop
Authority giving notice
Date of Notice

DayMonthYear
Details of notice

0/190
6. Encumbrances on lease
Encumbrances on lease

There are no encumbrances on the lease.There are the following encumbrances on the lease.
Name of holder of encumbrance
Nature of encumbrance

The encumbrance is to be discharged or satisfied prior to assignment of the lease.The encumbrance is not to be discharged or satisfied prior to assignment of the lease.
7. Encumbrances on, and third party interests in, fixtures and fittings within retail shop
Encumbrances on, and third party interests in, fixtures and fittings within retail shop

There are no encumbrances on, or interests of a third party in, any fixtures or fittings within the retail shop.There are the following encumbrances on, or interests of a third party in, any fixtures or fittings within the retail shop.
Name of holder of encumbrance or interest
Details of fixtures or fittings affected

0/200
Nature of encumbrance or interest

All encumbrances and interests are to be discharged or satisfied prior to assignment of the lease.The following encumbrances or interests are not to be discharged or satisfied prior to assignment of the lease.
Insert details

0/200
8. Rent concessions or other benefits
Rent concessions or other benefits

The lessor has not conferred any rent concessions or other benefits on the assignor during the term of the lease.The lessor has conferred the following rent concessions or other benefits on the assignor during the term of the lease.
Insert details

0/370
9. Annual sales figures
The total (aggregate) annual sales figures in respect of the retail shop during the past 3 years (or such lesser period as the lease has been in operation) are as follows. (Insert details)

0/190
10. Other information as to trading performance
The following further information has been provided by the assignor to the assignee as to the trading performance of the retail shop during the past 3 years (or such lesser period as the lease has been in operation. (Insert details)

0/540
Assignor Full Name
Address

0/300
Address
Acknowledgment of receipt

I acknowledge receipt of this disclosure statement.
Assignee Full Name
Address

0/300
uniqueSubmissionReference
Should be Empty:

Form 2 - Assignor's disclosure statement

1. Details of lessor

Address

Contact details

2. Details of shop for which lease is to be assigned

Address

3. Lessor's disclosure statement

4. Outstanding notices in respect of lease

5. Outstanding notices from any authority in respect of shop

6. Encumbrances on lease

7. Encumbrances on, and third party interests in, fixtures and fittings within retail shop

8. Rent concessions or other benefits

9. Annual sales figures

10. Other information as to trading performance

Address