This form should be completed when applying for authorisation to amend a registered Community Title Scheme.

	

Community Title Scheme please print

Community Title Scheme Number	

Developers / Body Corporate details please print

Surname	
		First name		
		
Company name	

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

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address	

Written Agreement of Persons with a Registered Interested 

Are there copies of the written agreement of each person with a registered interest in a lot
in the scheme for the land specified in this application attached?	•	NO
•	YES

Written Agreement of Prospective Owner’s 

Are there copies of the written agreement of each prospective owner of a lot in the scheme
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

Conflict of interest declaration

Does the applicant, lessee or buyer 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.

Description of Amendment to Community Title Scheme please print

Please tick one of these or a combination of these

	-  How the staged development is to be carried out

	-  Consequential amendments to the lot entitlement schedule

	-  Changes to the management statement

	-  Changes to the master plan

	-  Other

Lots affected

Note:  If there are more than three lots affected, by the amendments to 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	

Description of Amendments

Developer’s / Body Corporate’s declaration

I/we the undersigned, hereby apply to amend 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 body corporate:

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

Developer’s / Body Corporate 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.