For the purposes of section 186(3)(b) of the Law, the following information is prescribed--
(a) the applicant's name;
(b) contact details for the applicant, including an address for service of the decision;
(c) a statement setting out the grounds for the application to cancel the prohibition notice.
Note : Section 186(4) and (5) of the Law set out additional statements that may be included in the application.