Lodging Party (Insert Name)

	

CT
Form 011

APPLICATION FOR NEW CERTIFICATE 
OF TITLE

PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (C’WLTH)) OVERLEAF

1. LAND
Vol:Fol	Ed	District/Division	Section	Block	Unit	
     	     	     	     	     	     	

2. APPLICANT/S
First Name/s (Company Name)	Surname/s (A.C.N.)	Full Address (including postcode) of Applicant/s	
     	     	     	

3. CAPACITY OF APPLICANT/S (tick whichever is applicable)
Registered Proprietor/s	or	Legal Practitioner 	or	 Executor 	or	 Mortgagee in Mortgage No      	

4. NAME AND ADDRESS OF REGISTERED PROPRIETOR/S (Complete where the Applicant is NOT a registered proprietor)
First Name/s (Company Name)	Surname/s (A.C.N.)	Full Address (including postcode) of Registered Proprietor/s	
     	     	     	
 CONSENT (All mortgagees/encumbrancees to consent – registered proprietor to consent and state if NOT applicant)

I consent hereto and state that the registered proprietor is not presently an undischarged bankrupt or insolvent, and has not assigned the estate for the benefit of 
creditors and is not subject to the Confiscation of Criminal Assets Act 2003 . 

     

Full Name and Signature of Person and Capacity Under Which Consenting
(eg. Registered mortgagee)		Signature of witness

     

Printed Full name of witness	

     

Full Name and Signature of Person and Capacity Under Which Consenting
(eg. Registered mortgagee)		Signature of witness

     

Printed Full name of witness	

6. DATE
     	

I apply pursuant to section 62 of the Land Titles Act 1925 for the issue of a new Certificate of Title. The grant/current edition of the Certificate of Title described in Item 1 has been lost, mislaid or destroyed.  The Certificate of Title in Item 1 is subject to any mortgages, encumbrances and other instruments affecting the land, including any created by dealings lodged prior to this application.  In support of this application, I lodge herewith the following documents:

1.	Statutory declaration by me stating details of the loss of the grant/certificate of title; whether or not the registered proprietor resides at the property; that the grant or certificate of title is not held by any person as security for a loan or any other purpose whatsoever; and that the registered proprietor is not presently an undischarged bankrupt or insolvent, and has not assigned the estate for the benefit of creditors and is not subject to the Confiscation of Criminal Assets Act 2003.

2.	Statutory declaration by mortgagee or legal practitioner for the mortgagee as to the facts of the loss.

3.	A current A.C.T. Government General Land Rates Notice relating to the property.

7. EXECUTION
Signed by the applicant/s

Signature of applicant/s		Signature of witness

     

Printed Full name of witness	

8. LAND TITLES OFFICE USE ONLY
Lodged by	 	Attachments/Annexures	Stat Dec/Rates Notice/Probate	
Data Entered by		Registration Date		
Registered by				
PRIVACY STATEMENT
S.43 of the Land Titles Act 1925 (LTA) authorises the Registrar-General to collect the information required by this form for the establishment and maintenance of the Land Titles Register.  S.65-67 LTA requires that the Register be made available to any person for search, upon payment of a fee. The information is regularly provided to various ACT Government agencies, including Territory and Municipal Services, ACT Planning and Land Authority (the Authority), ACT Treasury, Canberra Connect and ActewAGL for conveyancing, municipal account, administrative, statistical and valuation purposes.  The Authority and agencies within Territory and Municipal Services may also use the information supplied to prepare and sell property sales reports to commercial organisations concerned with the development, sale or marketing of land.	

SCHEDULE OF NOTES

•	In the case of a lost grant or certificate of title, S.62(1) provides that the registered proprietor of land may apply to the Registrar-General for the issue of a replacement Certificate of Title.  In practice, this will be extended to a legal practitioner for the registered proprietor and to a registered mortgagee on title.  If the registered proprietor is deceased, the person entitled to be registered, or his/her legal practitioner, may apply.  Applications made under a Power of Attorney will be checked against the original Power of Attorney held in this office. An application made by one of several joint tenants or tenants in common must bear the consent of all other proprietors (except in the case of separate Certificates of Title).

Proof of the applicant’s identity and any further proof of ownership will be required.  In certain circumstances, holders of a Land Titles ‘Dial-A-Search’ account may be exempt from this requirement.  Acceptable forms of ID/proof include a combination of driver’s licence; passport; Medicare Card; pensioner card; rates notice; and Tax File Number.  The loss of a grant or Certificate of Title may be required to be reported to the Police. In such a case, the Registrar-General’s Office will contact the Police to confirm that the loss has been reported.  For security reasons replacement certificates cannot be posted to applicants.
•	Documents must be typed or completed preferably in black ink or biro.
•	Alterations to information entered on the form should be made by crossing out (not erasing or obliterating by painting over) and should be initialled by the parties.  
•	Volume, Folio and Edition references must be given.  
•	Provide the full name/s of the applicant and address/es of the applicant/s.
•	Provide the capacity under which the applicant is applying for the replacement Certificate of Title.
•	Provide the full name and address of the registered proprietor, where the applicant is not the registered proprietor.
•	Where the applicant is not the registered proprietor, the applicant must obtain the consent of all mortgagees/encumbrances and/or proprietor.
•	Execution by
A Natural Person – Should be witnessed by an adult person who is not a party to the document.
Attorney – if this document is executed by an Attorney pursuant to a registered power of attorney, it must set out the full name of the attorney and the form of execution must indicate the source of his/her authority eg. “AB by his/her attorney XY pursuant to Power of Attorney ACT Registration No…… of which he/she has no notice of revocation”.
Corporation – Section 127 of the Corporations Act provides that a company may now validly execute a document with or without using a Common Seal if the document is signed by:

Two directors of the company;
A director and a secretary of the company; or
Where the company is a proprietary company and has a sole director who is also the sole company secretary, that director. 
NB The normal witnessing provisions in the Land Titles Act 1925 do not apply to execution by a corporation as above, but do apply to execution by the attorney of a corporation.
Commonwealth of Australia
STATUTORY DECLARATION
Statutory Declarations Act 1959

1	Insert the name, address and occupation of person making the declaration	
I/We,1

make the following declaration under the Statutory Declarations Act 1959:	

2	Set out matter declared to in numbered paragraphs	
2

I/We understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.
	
3	Signature of person making the declaration	3

4	Place
5	Day
6	Month and year	Declared at 4                                            on 5                             of 6  

Before me,
	
7	Signature of person before whom the declaration is made (see over)
	7

8	Full name, qualification and address of person before whom the declaration is made (in printed letters)	8

	
Note 1   A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years — see section 11 of the Statutory Declarations Act 1959.
Note 2   Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 — see section 5A of the Statutory Declarations Act 1959.
A statutory declaration under the Statutory Declarations Act 1959 may be made before–
(1) a person who is currently licensed or registered under a law to practise in one of the following occupations:
Chiropractor		Dentist			Legal practitioner
Medical practitioner		Nurse			Optometrist
Patent attorney		Pharmacist			Physiotherapist
Psychologist		Trademarks attorney		Veterinary surgeon
(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); or
(3) a person who is in the following list:
Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public
Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)
Bailiff
Bank officer with 5 or more continuous years of service
Building society officer with 5 or more years of continuous service
Chief executive officer of a Commonwealth court
Clerk of a court
Commissioner for Affidavits
Commissioner for Declarations
Credit union officer with 5 or more years of continuous service
Employee of the Australian Trade Commission who is:
(a) in a country or place outside Australia; and
(b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and
(c) exercising his or her function in that place
Employee of the Commonwealth who is:
(a) in a country or place outside Australia; and
(b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and
(c) exercising his or her function in that place
Fellow of the National Tax Accountants’ Association
Finance company officer with 5 or more years of continuous service
Holder of a statutory office not specified in another item in this list
Judge of a court
Justice of the Peace
Magistrate
Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961
Master of a court
Member of Chartered Secretaries Australia
Member of Engineers Australia, other than at the grade of student
Member of the Association of Taxation and Management Accountants
Member of the Australasian Institute of Mining and Metallurgy
Member of the Australian Defence Force who is:
(a) an officer; or
(b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or
(c) a warrant officer within the meaning of that Act
Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants
Member of:
(a) the Parliament of the Commonwealth; or
(b) the Parliament of a State; or
(c) a Territory legislature; or
(d) a local government authority of a State or Territory
Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961
Notary public
Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public
Permanent employee of:
(a) the Commonwealth or a Commonwealth authority; or
(b) a State or Territory or a State or Territory authority; or
(c) a local government authority;
with 5 or more years of continuous service who is not specified in another item in this list
Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made
Police officer
Registrar, or Deputy Registrar, of a court
Senior Executive Service employee of:
(a) the Commonwealth or a Commonwealth authority; or
(b) a State or Territory or a State or Territory authority
Sheriff
Sheriff’s officer
Teacher employed on a full-time basis at a school or tertiary education institution