[The information in Part A is to be provided to the assignee (together with an updated lessor's disclosure statement) and the signed statement in Part B is to be provided to the lessor if the lessee requires the protection of section 41A.]
The assignor (the lessee under the lease to be assigned) provides the following information about the lease to the assignee (the proposed new lessee)--
(a) There are/are no outstanding notices in respect of the lease.
[insert details of any outstanding notices]
(b) There are/are no outstanding notices from any authority in respect of the retail shop.
[insert details of any outstanding notices]
(c) There are/are no encumbrances on the lease.
[insert details of any encumbrances]
(d) There are/are no encumbrances on, or outside ownership of, any of the fixtures and fittings within the retail shop.
[insert details of any encumbrances or outside ownership]
(e) The lessor has/has not conferred rent concessions or other benefits on the assignor during the term of the lease.
[insert details of any rent concessions or benefits]
(f) Total (aggregate) sales figures for the past 3 years (or for such period as the lease has been in operation if that period is less than 3 years) are as follows--(i) [insert period/year]$(ii) [insert period/year]$(iii) [insert period/year]$
Part B Certification and acknowledgement I certify that I have provided the assignee with the information indicated in paragraphs (a)-(f) and an updated lessor's disclosure statement.
Assignor--
Date--
I acknowledge receipt from the lessee of the information indicated in paragraphs (a)-(f) and an updated lessor's disclosure statement.
Assignee--
Date--