ACT Revenue Office
Department of Treasury	

Application for Discount — Land Rent

NOTE
•	Lessees must read the ‘Terms and Conditions’ at the end of this form.  The meaning of words in bold is provided in the ‘Terms and Conditions’.
•	Lessee includes all lessees and proposed lessees, and all lessees must complete and sign the form.  If there are more than two lessees, an additional form must be completed and attached to the original form.
•	Lessees must provide the required details and must complete all sections of the form.  Incomplete declarations or declarations without the required supporting information may result in the application being rejected. 

Details for lessee 1 (primary contact)
Personal details	
Title	Given name(s)	Family name	

Current residential address	
Street Address	Suburb	State	Postcode	

Contact details	
Telephone	Email	

Details for lessee 2
Personal details	
Title	Given name(s)	Family name	

Current residential address	
Street Address	Suburb	State	Postcode	

Details of property subject to Land Rent
Suburb	Section	Block	Street address	Postcode	

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 (Commonwealth).  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.

Section 1	Eligibility
Does the total income of all lessees exceed the income threshold amount?	Yes    No	
Do any of the lessees own any other real property other than the subject property?	Yes    No	
Will at least one lessee occupy the property as his/her principal place of residence?	Yes    No	
How many dependent children do the lessees have? (circle one)	0 1  2  3  4  5 or more	

Section 2	Dependent children
First Name and Surname	Date of birth (dd/mm/yy)	First Name and Surname	Date of birth (dd/mm/yy)	
1.		4.		
2.		5.		
3.		6.		

Section 3	Income details 
All lessees must list their total income from all sources received during the current year (to date) and the year prior to the date of the application.  Non-assessable Eligible Termination Payments, such as those made for years of service under a bona fide redundancy package, are excluded.  	
To substantiate your income details, each lessee must provide the following
(or a reason for not providing these documents):	Copies attached	
1.   evidence of total income for the current year (to date) and the year prior to the date of the application;	Yes     No  	
2.   a current pay slip showing year to date totals, prior to the date of the application.  If your pay slip does not show year to date totals, provide copies of your last four (4) pay slips or a letter from your employer;	Yes     No  	
3.   if you are self-employed, a copy of all Business Activity Statements (BAS) for the current year (to date) and the year prior to the date of application;  and	Yes     No  	
4.   a copy of the last income tax return, Centrelink statements or other income statements prior to the date of the application.	Yes     No  	

Income details for lessee 1
Total income as shown on	Name of employer	Current year (to date) income	Prior year income	
Last income tax return				
Centrelink statements				
Other income statements				
Other				
Total				

GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (section 338 Criminal Code 2002)	

Income details for lessee 2
NOTE	Use an additional form if there is income from any another person 
Total income as shown on	Name of employer	Current year (to date) income	Prior year income	
Last income tax return				
Centrelink statements				
Other income statements				
Other				
Total				

Office use only	Lessee 1	$	
	Lessee 2	$	
	Total Income for all sources		

Section 4	Declaration and undertaking
NOTE	All lessees must sign
I/we …………………………………………………...................................................................................... 
of ……………………………………………………………… being the lessee/s, declare that: 
1.	by signing this form I am making an application for discounted land rent;
2.	all of the information in this application including any attachments is true and correct, and to the best of my knowledge, no information relevant to the consideration of my application has been omitted;
3.	I have attended the compulsory Land Rent Information Course at the Canberra Institute of Technology and provided evidence of my attendance (attach copy);
4.	the income details I have provided are an indication of my usual income (attach copies);
5.	I have read and understood the ‘Terms and Conditions’ at the end of this form and I understand that, depending on the circumstances, interest may apply to any underpayment of Land Rent.
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 understood the Privacy Statement.	
Lessee 1	
Signature:	Date:	
Lessee 2	
Signature:	Date:	

Office use only	Delegate name	Signature	Date	
				
	Unimproved value	Land rent account number	Approved	
	$		Rejected	

 
Terms and Conditions 
Application for Discount — Land Rent

NOTE	Each lessee MUST read and understand this information before completing and submitting the application.
Conditions
•	Applications to be granted discounted land rent may only be made on a single dwelling house land rent lease granted under the Planning and Development Act 2007.  	
•	Applications to be granted discounted land rent may be made before the grant of the lease or at any time during the term of the lease.	
•	Applications to be granted discounted land rent received during the term of the land rent lease, if approved, will take effect from the start of the next year.	
•	To be eligible for the discount, all applicants must be lessees who meet the following criteria:
-  the lessee, or any of the lessees, must not own other real property; and 
-  the total income of the lessee, or all of the lessees, must not exceed the income threshold amount; and
-  if a certificate of occupancy is issued for the land rent lease – the lessee, or at least 1 of the lessees, must live on the property under the lease. 	
•	All lessees must attend the compulsory Land Rent Information Course at the Canberra Institute of Technology (at no cost to them) prior to applying for discounted land rent, and provide evidence of their attendance to the ACT Revenue Office.	
•	All lessees currently paying discounted land rent must lodge an Annual Review of Eligibility for Discounted Land Rent Form between 1 July and 30 September each year to demonstrate their continuing eligibility for discounted land rent. 
A lessee who is determined to be ineligible to continue to receive discounted land rent because the total income of the lessee, or all of the lessees, exceeds the income threshold amount, will commence paying land rent at the standard (non‑discounted) rate following the next annual review of eligibility.
Loss of eligibility for discounted land rent because one of the lessees becomes the owner of other real property or all of the lessees stop living on the subject property will result in land rent being payable at the standard rate, effective from the 1st quarter after the circumstance has occurred.   	
•	Lessees acknowledge that if a land rent lease is transferred, land rent will be payable at the standard percentage of the unimproved value of the property under the land rent lease.	
•	Lessees acknowledge that interest will accrue on the amount of unpaid Land Rent at the determined rate from the day the amount becomes payable until the day the amount is paid.  If an amount remains unpaid for part of a month, then interest is payable for the whole of the month.  For example:
Andrew’s land rent is due on 1 April.  He doesn’t pay it until 15 May.  Andrew has to pay interest worked out for the overdue period from 2 April to 15 May.  Because of the operation of section 22 (2) of the Land Rent Act 2008, Andrew has to pay interest for the period 2 April to 1 June. 	
•	Lessees acknowledge that any outstanding land rent or interest will be held as a charge against the property under the land rent lease.	
•	Lessees acknowledge that all outstanding land rent and interest must be paid in full prior to the property being sold.	
•	Lessees will be notified in writing whether or not they have been successful in their application.	
•	Lessees are required to notify the ACT Revenue Office if they no longer reside in the property, or become the owner of other real property, within 30 days of the change in circumstance.	
•	Lessees acknowledge they have had the opportunity to obtain independent financial advice prior to signing the declaration in this form.	
•	Lessees acknowledge that giving false or misleading information is a serious offence under the Criminal Code 2002 and the ACT Revenue Office may prosecute any lessee found to have provided false or misleading information in an application.	

Terms 
Dependent Child	has the same meaning as in the Social Security Act 1991 (Cth)	
Determined Rate	in relation to interest, means the rate determined under s 139 of the Taxation Administration Act 1999	
Discounted Land Rent	refers to the discount granted under part 3 of the Land Rent Act 2008.	
Income Threshold Amount	means the income threshold amount with reference to the number of dependent children the lessees  have as specified in the instrument applicable at the time of declaration: see the instrument at www.revenue.act.gov.au 	
Lessee	in relation to a proposed land rent lease, includes a person proposed to be a lessee under the lease.    Lessee refers to all individuals who appear on the land rent lease and who on completion of the purchase will be an owner of the subject property.  Lessee includes all lessees.	
Total Income	means the total income of all persons named on the land rent lease, transfer or agreement for transfer of the subject property	
Year	means a financial year