LAND TITLES
OFFICE OF REGULATORY SERVICES
Department of Justice and Community Safety

SURVEYOR’S DECLARATION		
Form 087 - SD	

	Land Titles Act 1925		

LAND DETAILS	
Volume & Folio	District / Division	Section	Block	Deposited Plan Number	Units Plan Number	
     	     	     	     	     	     	

NAME OF MANAGER / OWNERS CORPORATION	
     	

ADDRESS FOR SERVICE OF NOTICE	
     	

SURVEYOR’S DECLARATION	
I, 	     	of	     	
A surveyor registered under the Surveyors Act 2007, hereby certify that:	
1.	The survey represented by the diagrams on forms 1A and 3 of this plan are accurate and have been made by me / under my immediate supervision (delete whichever is not applicable) and was completed on (insert date) - 		
2.	The survey is in accordance with the following Acts:	•	Unit Titles Act 2001;
•	Land Titles (Unit Titles) Act 1970;
•	Land Titles Act 1925; and,
•	any other Regulation made under those Acts and in accordance with the Surveyors Practice Directions.	
CROSS OUT EITHER OF ITEM 3 OR 3(a)-3(c), WHICHEVER DOES NOT APPLY – 3(a)-(c) CANNOT APPLY IF AN ENCROACHMENT OCCURS OVER A ROAD OR PUBLIC PLACE UNLESS THE ENCROACHMENT IS AN ATTACHMENT AS DEFINED BY THE UNIT TITLES ACT 2001.	
3.	Each building (including anything attached to it) or building in the course of erection on the parcel is wholly within the parcel.	
OR	
3 (a), (b), (c)	a)	All units and unit subsidiaries shown in the diagrams are wholly within the parcel;
b)	The diagram clearly indicates the existence, nature and extent of any encroachment by a building (including anything attached to it), beyond the boundaries of the parcel; and,
c)	The diagrams clearly indicate the existence, nature and extent of any easement granted and registered, or to be granted and registered upon registration of this proposed plan, pertaining to the parcel.	
Signature of Registered Surveyor	            Dated	
 APPROVED UNDER THE UNIT TITLES ACT 2001, 
AS THE UNITS PLAN FOR THE SUBDIVISION OF THE ABOVE MENTIONED PARCEL OF LAND	
Delegate of the Authority / Executive	            Dated	
OFFICE USE ONLY	
LODGED BY		REGISTERED BY		
EXAMINED BY		REGISTRATION DATE		
DATA ENTERED BY