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| 5. a) Full name of Agent | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

This certificate provides confirmation that the owner of the land which is the subject matter of the application is either the applicant or is fully aware of the application.
The certificate constitutes a statement of ownership and is not proof of ownership.
The applicant is requested to complete either Statement A or Statement B and return the completed certificate along with the planning application form and any supporting documents.
NO APPLICATION WILL BE PROCESSED UNTIL SUCH TIME AS THE CERTIFICATE IS SUBMITTED.
I certify that the accompanying application is made by or PUBLICING COPY of the land, namely:
Mrs J. HASSON
(Full names in CAPITAL letters)
who is:
If the application is made on behalf of the land owner, a certified copy of the power of authority signed by the owner authorising the application on his behalf is attached hereto.
I certify that appropriate written notice of the accompanying application has been given by or on behalf of the applicant to:
The persons upon whom notice was issued are:
| Name & Address | | Name & Address | | | --- | --- | --- | --- | | | | | | | Interest | | Interest | | | Date | | Date | |
The Department of Food and the Environment (DEFA) is a data controller for the purposes of the Data Protection Legislation and will only process your data in accordance with the principles in that Act. The processing of any personal data is necessary to comply with The Town and Country Planning (Development Procedure)(No2)Order 2013. DEFA will only hold your data for as long as is necessary for that purpose, and in accordance with our P&BC Privacy Notice, details of which can be found on our website.
| Signature Applicant/Agent | Date | | --- | --- | | | |
Planning and Building Control Directorate, Department of Environment, Food and Agriculture Murray House, Mount Havelock, Douglas, Isle of Man, IM1 2SF Tel: +44 1624 685950 Fax: +44 1624 686443 Email: [email protected]

Certificate 01.1(i)
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