Report by the Responsible Entity of a Wholesale Unit Trust Scheme
NOTE
•	This report must be completed by the responsible entity of a wholesale unit trust scheme registered under section 95D of the Duties Act 1999.
•	The declaration in this report must be completed by an authorised officer of the responsible entity.
Details of the wholesale unit trust scheme
Name of unit trust  	
Name of responsible entity   	ABN	
Address	
Suburb	State\Territory  	Postcode  	

Contact name  	Email	Phone  	

Reportable acquisitions
NOTE	This report must disclose any acquisitions in the period of 12 months ending on 30 June, being:
•	an acquisition of an interest of no less than 20%; or
•	an acquisition of an interest that, when aggregated with other interests of the person acquiring the interest, amounts to no less than 20%.

Reportable acquisitions in the scheme in the 12 months to 30 June 20____	
Date	Name and address of person who acquired the interest  (If acquired as trustee of the responsible entity, include the name of the trust or scheme)	Interest held prior to the acquisition (%)	Interest acquired (%)	

				

				

				

				

Declaration
I…………………………………………………...................................................................................... 
an authorised officer of the resonsible entity, declare that by signing this declaration I am declaring that all of the information in this report including any attachments is true and correct and, to the best of my knowledge, no information relevant to the consideration of my declaration has been omitted.
I understand that giving false or misleading information is a serious offence under the Criminal Code 2002.
I also acknowledge that I have read and understand the Privacy Statement.	
Signature:	Date:	

PRIVACY STATEMENT
All information collected by the ACT Revenue Office is protected by secrecy provisions in Acts administered by the Office and only used for the purposes of those Acts. In addition, personal information provided to the ACT Revenue Office is protected by the Privacy Act 1988 (Cth).  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.
GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (section 338 Criminal Code 2002)