This form is to be completed if you require a rural rapid number. Residential dwellings, commercial business, workshop, dairy shed or any other regularly occupied building in the rural area need to have a rapid number so that emergency services can easily find you.

* = required field

Your Details

Request made by *
Your name and company name if you are requesting a number on behalf of the owner

Owners Name *
If property is owned by a trust please supply the trust name

Phone Number *
Cellphone or landline

Email Address

Property Details

Road Name of Property *

Vehicle Entrance Location

Legal Description of Property
If known - this can be found on your rate demand

Valuation Number
This can be found on your rate demand

Entrance Formed?

New or Damaged Post*

Notes
Please give us any other information or identifying features of your property also if the post is damaged the extent of the damage

Before submitting: Please ensure you have answered all questions.

Privacy statement

The personal information you provide in this form will be collected, held and protected by Selwyn District Council in accordance with our Privacy Policy and the Privacy Act 2020. Our Privacy Policy explains how we use and share personal information in relation to any interaction you have with Council, and how you can access or correct your information at any time.

You can read the full policy at selwyn.govt.nz/privacy.

We will use the email address you provide to send communications directly related to this form or application. By submitting this form, you consent to receive those communications by email. If you require a hard copy, please email ContactUs@selwyn.govt.nz, visit our Service Desk Team or call 0800 SELWYN (735 996).