Absentee Advice Form

Absentee Advice Form
The Absentee Advice form advises NT Police, Fire and Emergency services of your absence. The form provides details on who to contact in the event of an emergency at your premises.

Enjoy your break!
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Vacant Premises
Name

First NameLast Name
Address

Street Address

Street Address Line 2

SuburbState

Postal Code
Business Name (if applicable)
Email
example@example.com
Phone Number
Destination
Date of Absence from

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Date of Absence to

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
If Travelling by car: Make
Type
Colour
Reg No
Emergency Contact Details for Premises
Name

First NameLast Name
Address

Street Address

Street Address Line 2

SuburbState

Postal Code
Phone Number
Does this person have keys to the premises
By submitting this form you agree to the information provided being shared with Northern Territory Police, Fire and Emergency Services (NTPFES).

For more information on your privacy please refer to the Privacy Act 1988
Should be Empty: