Approved form AF2002-234

approved by the delegate of the Minister for Planning on 21 November 2002 under the
Unit Title Act 2001, s 180 (Approved Forms)

Unit Title Act 2001 – Form 7
(see s 154)

Australian Capital Territory

Provisional Building Damage Order Certificate

(See attached form entitled Provisional Building Damage Order Certificate)

Unauthorised version prepared by ACT Parliamentary Counsel's Office

Planning and Land Management

OFFICE USE ONLY
Fees

Date received
/	/
Receipt number

Receiving officer

Australian Capital Territory Government

Unit Titles Act 2001 - Form 7

Provisional Building Damage Order Certificate

When should you use this form?

This form should be completed when applying for a certificate certifing that the elimination or reinstatement of a building or part of a building or a unit or part of unit in a units plan is exempt from the requirement to obtain development approval under part 6 of the Land Act.
Please supply the following with your application:
•	plans for the elimination or reinstatement of the building(s)/unit(s)
•	the application fee;
•	if you are an agent: authority to act on behalf of the owners corporation or unit owner;
•	any additional information necessary to finalise your application.

Privacy Notice: The personal information on this form is being collected to enable processing of your application. Collection of personal information is authorised by Part 15 of the Unit Titles Act 2001.

Part 1:	Lease/Site details

Block Section Suburb
Units No.

Street address

Part 2:	Applicant details

Surname or Company name
Title / First Name / Initials or Australian Company Number (ACN)
If a company Name of contact person

Postal address

Suburb

State/Territory Postcode
Phone number (business hours)

Fax number

Email

Unauthorised version prepared by ACT Parliamentary Counsel's Office

UT Approval Form7-11/02

Part 3:	Applicant’s declaration

I/we the undersigned, being the applicant(s) nominated in this application, hereby apply for a provisional building damage order certificate described in this application on the land specified in this application.
I/we hereby authorise ACT Government Officers to access the subject property(s) for the purpose of evaluating the proposal.
I/we understand that payment of additional fees may be required.
I/we declare that all the information I/we have given on this form and its attachments is true and complete.

Signature(s) If a company,  capacity/authority
Date

Part 4:	Unit Owner/Owners corporation details

1st Unit Owner/Executive Member’s details (If the same as applicant, write ‘see applicant’) Surname or Company name

Common Seal

Title / First Name / Initials or Australian Company Number (ACN)
If a company Name of contact person

Postal address

State/Territory

Suburb Postcode
Phone number (business hours)

Fax number

Email

Unit Owner/Executive Member’s Signature
Signature

2nd Unit Owner/Executive Member’s details
Surname or Company name
Title / First Name / Initials or Australian Company Number (ACN)
If a company Name of contact person

Postal address

State/Territory

Suburb Postcode
Phone number (business hours)

Fax number

Email

2nd Unit Owner/Executive Member’s Signature

Signature

UT Approval Form7-11/02

Unauthorised version prepared by ACT Parliamentary Counsel's Office

Part 5:	Description of Building Work

Please tick appropriate box

-	Elimination of a building or part of building or a unit or part of a unit

-	Reinstatement of a building or part of building or a unit or part of a unit

Description

Unauthorised version prepared by ACT Parliamentary Counsel's Office

UT Approval Form7-11/02