PLEASE NOTE:

This application is for approval to payout the land rent on both Residential Land Rent Scheme Crown leases and all other land rent Crown leases eligible to payout the land rent in accordance with Disallowable Instrument No 2009-162.

Disallowable Instrument No 2009-162 provides for the Lessee, where applying to payout the Residential Land Rent Scheme, to pay either the unimproved value on the current Rates Assessment Notice OR the current market value as prepared by a member of the Australian Property Institute. 

Disallowable Instrument No 2009-162 requires the Lessee, where applying to payout the land rent for other than Residential Land Rent Scheme Crown leases, to provide a valuation report prepared by a member of the Australian Property Institute. 

Lease details please print

Block	

Section	
	Suburb		
		
Unit 
(if applicable)	

Street number	

Street name	

Postcode	

Applicant details please print

Surname	
		First name		
		
Company name	

Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile	*	
		
Email address

Lessee details please print

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	*

* - Optional

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.

DOCUMENTS REQUIRED:

If the application relates to a Registered Units Plan, you are required to provide an:

Unopposed Resolution

Is an unopposed resolution of the Owners Corporation attached?	•	NO
•	YES

If there is a conflict of interest, you are required to provide details below:

Conflict of interest declaration

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

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

If paying the unimproved value on the current Rates Assessment Notice for a Residential Land Rent Scheme Crown lease, you are required to provide a:

Rates Assessment Notice (unimproved value)

Is a current Rates Assessment Notice from ACT Revenue Office attached?

If choosing to pay the unimproved value from the current Rates Assessment Notice, please nominate
a date to pay this amount.  The date can be no earlier than 3 weeks from the date of lodgement of
this application:

DATE:  _______________________
	•	NO
•	YES
	
ACT Revenue Statement

Is an ACT Revenue Statement providing that all rent, land tax (if applicable) and rates have been paid
up until the date nominated in this application attached?	•	NO
•	YES

If paying the current market value as prepared by a member of the Australian Property Institute for a Residential Land Rent Scheme Crown lease OR for all other land rent Crown lease payouts, you are required to provide a:

Valuation Report (current market value)

Is a valuation report of the current market value of the land dated no later than 2 weeks before the
date of lodgement of this application attached?	•	NO
•	YES
	
ACT Revenue Statement

Is an ACT Revenue Statement providing that all rent, land tax (if applicable) and rates have been paid
up until the date of this application attached?	•	NO
•	YES

Applicant, Lessee declaration

I/we the undersigned, hereby apply to payout the land rent payable on the lease specified in this application.

I/we declare that this application is accompanied by all of the required information or documents for it to be considered for approval.

I/we the undersigned appoint the applicant whose signature appears below to act on my/our behalf in relation to this land rent payout application. This authorises the applicant to pay all application fees and liaise with ACTPLA when required, alter, amend or provide further information as necessary and receive any communications relating to this land rent payout application.

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 organisation:

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

Applicant signature (s)	
	Date		
				
First lessee’s signature	
	Date		
				
Second lessee’s signature	
	Date		

Privacy notice

The personal information on this form is being collected to enable processing of your application.  Collection of personal information is authorised by Chapters 7, 8 and 9 of the Planning and Development Act 2007.  The information that you provide may be disclosed to Government Agencies such as the ACT Revenue Office and the Registrar-General’s Office.

Contact details:	
ACT Planning and Land Authority	
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