New South Wales Consolidated Acts(Section 41)
This statement is to be provided to the lessor when a lessee is requesting the lessor to agree to the assignment of a lease. In these circumstances the lessee is the assignor and the proposed new lessee is the assignee. The purpose of the form is to assure the lessor that the assignee has been made aware of the information specified as necessary for the assignment process, as set out in section 41 of the Retail Leases Act 1994 . The lessor may take up to 28 days to consent to, or reject, the assignment of the lease, once the lessor receives all the information referred to in this disclosure statement. If the lessor does not respond in this period, the assignment is deemed to have been consented to.
The assignor certifies and the assignee acknowledges that:
(a) The assignor has provided the assignee with 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.
(b) The assignee has been advised that there are no outstanding notices in respect of the lease.
(c) The assignee has been advised that there are no outstanding notices from any authority in respect of the retail shop.
(d) The assignee has been advised that there are/are not any encumbrances on the lease.
(e) The assignee has been advised that there are/are not any encumbrances on, or outside ownership of, any of the fixtures and fittings within the retail shop.
(f) The lessor has/has not conferred any rent concessions or other benefits on the assignor during the term of the lease. The concessions and benefits conferred on the assignor are:
(g) The assignor has provided to the assignee sales figures and relevant information as to the trading performance of the retail shop for the past three years or for such period as the lease has been in operation if that period is less than three years. The total (aggregate) sales figure for the past 3 years, or such lesser period as the lease has been in operation, is as follows:(i) (period/year)$(ii) (period/year)$(iii) (period/year)$
This information is to be given to the lessor in writing, by:(a) delivering it personally, or(b) leaving it at or posting it to the last known residential or business address of the lessor,or in any other manner referred to in section 81A of the Act.
Further information to be provided to the lessor about the assignee by the assignor in seeking consent to assignment is:(a) details of the assignee(b) documentation showing the financial standing of the assignee(c) business experience of the assignee(d) written statements of things said by the assignor or lessee which influenced the assignee to enter the assignment
I certify that I have provided the information set out in paragraphs (a)-(g) to the assignee.
Assignor:
Date:
I acknowledge receipt of the information as set out in paragraphs (a)-(g).
Assignee:
Date: