When should you use the application to apply for a further lease?

	
The form is required to apply for a further Crown lease for land within the ACT either for the same term as the original lease or for an additional term.

	
Lease details please print

         Block	

Section

Suburb

Units Plan Number (if applicable)                                                           

                                                            

Street Address	

Postcode	

Applicant details please print

Surname	
		First name		
		
Company name	

Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address

Lessee (Owners) details please print

First lessee’s details

Surname	
		First name		
		
Company name	

Position held in company			Australian Company/Business Number (ACN/ABN)		
		
Street address
(not a PO Box)	

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)		
		
Street address
(not a PO Box)	

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.

Registered Interests (ie: Mortgagee, Caveator etc) please print

First Registered Interests 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 Registered Interests 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	

Company or Incorporated Association –

Form of words used in attestation/signing legal documents (e.g. The Common Seal of ..... was hereto affixed in the presence of .....)

_________________________________________________________________________________________________

_________________________________________________________________________________________________

		

Summary Information please print

Type of lease the applicant is seeking

	Non-Rural

	Commercial 	Residential	Industrial 	Unit Title 	Other 

	Number of years:	99 years 	Same as original term 	Other (specify) 

Rural (lease to accord with current policies)

Type of lease the applicant is seeking

	Long term 	Short term

Please nominate the form of payment

	Lump sum	Partial lump sum plus 30 years for remainder 	30 year payout

	Number of approved dwellings on site

	Does the purpose clause of your lease allow for agistment?

	If Yes how many horses do you agist? 

Applicant’s & Lessee’s declaration

I/we the undersigned, hereby apply for the grant of a Further Crown lease 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;

I/we the undersign appoint the applicant whose signature appears below to act on my/our behalf in relation to this application for the grant of a Further Crown lease.  This authorises the applicant to pay all application fees and liaise with ESDD when required, alter, amend or provide further information as necessary and receive any communications relating to this application for the grant of a Further Crown lease.

I/we declare that all the information given on this form and its attachment is true and complete; and

I/we acknowledge that the Planning and Land Authority intends to make a decision on whether the lease is concessional.

CONFLICT OF INTEREST DECLARATION:	Does the applicant or lessee have any association with Planning and Land 
	Authority staff? 	No 	Yes

If yes, please provide details:  __________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

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.

Applicant signature (s)	
	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 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.