Approved form AF2002-  17

approved by the delegate of the Minister for Planning on 8 February 2002 under the

Lands Acquisitions Act 1994, s118

Lands Acquisitions Act 1994 – Form 1
(see s 118)

Australian Capital Territory

Lands acquisition compensation claim form

Lands Acquisitions Act 1994

Claim for Compensation - Compulsory Acquisition

I/We, the claimant described in item 1, hereby claim compensation, in accordance with the provisions of the Lands Acquisitions Act 1994, for the compulsory acquisition of the interest in land described in item 2. Particulars of the claim are as follows:

Item 1	Name/s and address/es of claimant:

[Note – where the interest is registrable, the claimant should correspond to the person named on the Certificate of Title under the Land Titles Act 1925)

Item 2	Interest in land of the claimant that has been compulsorily acquired:

Item 3	The amount of compensation claimed in respect of the acquisition:

(NOTE:	Mortgagees should calculate compensation in accordance with section 54 of the Act, and identify each of the amounts referred to in that section.
Mortgagors should calculate compensation in accordance with sections 45 to 52 inclusive.)

Item 4	If the claim is in respect of the acquisition of a mortgage interest under a mortgage - specify the amounts referred to in paragraph 56(2)(b)(iii) of the Act:

Dated this                                        day of                                        2002

[Where the claimant is a natural person]

Signed by 
[print name]						...............................
in the presence of 					       Claimant

........................................................

Witness

[Where the claimant is a company]

The Common Seal of 			)
[insert full name and ACN of		) 			...........................................
Company was hereto affixed		)			Director/Secretary
in the presence 			)

........................................................
Director/Secretary