This form should be completed when applying for approval of a Community Title Scheme.	

	
Lots to be included in the Scheme please print

Note:  If there are more than three lots in the community title scheme please ensure that additional lot details are attached to this application.

	Block	Section 	Suburb 

Postal address	

	Block 	Section 	Suburb  

	
Postal address	

	Block	Section 	Suburb 

Postal address	

Developers details please print

Surname	
		First name		
		
Company name	

Position held in company			Australian Company/Business Number (ACN/ABN)		
		
Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address	

Lessee (owners) details please print

Note:  If the lessee is the developer, write “see developer’s details”

	First lessee’s details

Surname	
		First name		
		
Company name	

Position held in company			Australian Company/Business Number (ACN/ABN)		
		
Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address	

Second lessee’s details

Surname	
		First name		
		
Company name	

Position held in company			Australian Company/Business Number (ACN/ABN)		
		
Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address	

All lessees must sign authorising the lodgement of this application. In doing so the lessee gives authority to the applicant to negotiate any dealings in relation to the application through to its determination. If there are more than two lessees please ensure that the details and authorisation are attached to the application.

Master Plan

Is a master plan for the land specified in this application attached?	•	NO
•	YES

Management Statement 

Is a management statement for the land specified in this application attached?	•	NO
•	YES

Constituent Documents for the Body Corporate

Are the constituent documents for the body corporate to be formed on registration for 
the land specified in this application attached?	•	NO
•	YES

By-Laws of the Body Corporate	

Are the by-laws of the body corporate for the land specified in this application attached?	•	NO
•	YES

Certification of Lot Entitlement

Is a certification of the lot entitlement by a member of the Institute of Valuers for the 
land specified in this application attached?	•	NO
•	YES

Form 2 – Requirements & Checklist

Is Form 2 – Requirements and Checklist for the land specified in this application attached?	•	NO
•	YES

Conflict of interest declaration

Does the developer or lessee have any association with the Planning and Land Authority staff?          	•	NO
•	YES
	
If YES - please provide details:	

	

NOTE: There are penalties for deliberately giving false and misleading information.  The Planning and Land Authority or Planning Minister may revoke an approval if satisfied that the approval was obtained by fraud or misrepresentation.

Scheme details please print

Please provide a brief description of the type of community title scheme you are applying for:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

________________________________________________________________________________________________

Type of Scheme
(please tick one of these or a combination of these)

	Commercial 	Residential	Industrial 	 

	Unstaged	

	Staged 	A bond may be required to provide security for a staged development.

	(If more than 3 stages, please provide details separately)

	Cost of total development	$ ___________________

	Cost of stage 1	$ ___________________

	Cost of stage 2	$ ___________________

	Cost of stage 3	$ ___________________

Does the proposed community title scheme include any of the following:

	Unit Title		Partly development land 	

	Development Application	Undeveloped land

	Fully developed land

Developer’s & Lessee’s declaration

I/we the undersigned, hereby apply for approval of the Community Title Scheme on the land specified in this application;

I/we understand that the requirements set out in this form are a minimum only and that additional information may be requested during processing; and

I/we declare that all information given on this form and its attachments is true and complete.

If signing on behalf of a company or organization:

I/we the undersigned, declare I/we have the appropriate delegation or authority to sign on behalf of the company or organization.

Developer’s  signature	
	Date		
				
First lessee’s signature	
	Date		
				
Second lessee’s signature	
	Date		

Contact Details:
Environment and Sustainable Development Directorate
Customer Service Centre
GPO Box 1908, Canberra City 2601
16 Challis Street, Dickson ACT 2602
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays)
Phone: (02) 6207 1923                    Fax: (02) 6207 1925      	TTY: (02) 6207 2622
Email:  actpla.customer.services@act.gov.au	Website: www.actpla.act.gov.au	

Privacy Notice
The personal information on this form is being collected to enable processing of your application. Collection of personal information is authorised by the Community Title Act 2001. The information that you provide may be disclosed to Government Agencies such as the ACT Revenue Office and the Registrar-General’s Office.