LAND TITLES
OFFICE OF REGULATORY SERVICES
ACT Justice and Community Safety Directorate

ELECTRONIC FUNDS TRANSFER FOR
ON-LINE LAND TITLES CLIENTS		
Form 120 - LOS	

	Land Titles Act 1925		

PLEASE NOTE – If you opt to pay your Land Titles On-Line account by EFT, you must email a copy of this form to both the Land Titles unit and ORS Finance and Budgets unit (email details are provided below).  If you do not send email notification of payment at the time of payment there will be significant delays allocating funds to the correct LOS user.

LAND TITLES ON-LINE (LOS) ACCOUNT DETAILS	
Name of Account	LOS Number	
     	     	

CUSTOMER DETAILS	
Name of Authorised Person (in full)	Contact Telephone Number	
     	     	

CUSTOMER SIGNATURE & DATE	
Signature of Authorised Person (who is listed above)	Date	
     	     	

INVOICE / PAYMENT DETAILS	
Invoice Period
(Please indentify month on the statement – ie, May 2013)	Invoice Amount
(Account will not be accessible by the 15th of the month
 if total amount owing on monthly statement is not paid in full)	
     	     	

JACS ACCOUNT DETAILS (Please pay outstanding amounts directly into the following Departmental account)	

ACCOUNT NAME:		ACT Justice and Community Safety Directorate RBT account
BSB:				032-777
ACCOUNT NUMBER:	000348

EMAIL NOTIFICATION (Please email a copy of this signed form to BOTH email accounts listed below)	

LAND TITLES:		actlandtitles@act.gov.au
BUSINESS & FINANCE:	orsofficesupport@act.gov.au

OFFICE USE ONLY	
LTO Actioning Officer		Date receipted in Tarquin		
Notification Received on		Payment Confirmed on