Lease details please print

If more than one lease/site, attach the following details for each lease/site

Block/s	
	Section 		Suburb			

Street Address	

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

1st Lessee’s Details

Surname	
		First Name		
		
Company Name	

Position held in company			Australian Company  Number (ACN)		
		
Postal Address	

Phone Number Business Hours			Mobile		
		
Email Address	

2nd Lessee’s Details

Surname	
		First Name		
		
Company Name	

Position held in company			Australian Company  Number (ACN)		
		
Postal Address	

Phone Number Business Hours			Mobile		
		
Email Address	

All lessees must sign authorising the lodgement of this application for unit title. 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.

Endorsement of Units Plan for Registration

Your approved Units Plan will be held for collection.

Unit Details 

Type of units
	•	Class A		Number of Units   _______________	
	OR
	•	Class B		Number of Units  ________________	
Class A units are defined by reference to the floors, walls and ceilings of the building. Class B units are unlimited in height except to the extent of any encroachment at, above or below ground level by another part of the parcel.
The development is
	•	Residential		•	Commercial/Industrial	
	•	UnStaged 		•	Staged (minimum of 4 units can be staged)
	
If a staged development, please complete the following stage and costing details
	Stage 1		Unit No.  ________ to _________	
	Stage 2		Unit No.  ________ to _________	
	Stage 3		Unit No.  ________ to _________	
(If more than 3 stages, please provide details separately)
	Cost of total development		$ _______________	
	Cost of outstanding building works		$ _______________	
	Cost of outstanding site works		$ _______________	
Information required for the preparation of a Deed of Unconditional Undertaking: 
	Name of Financial Institution		__________________________________________________________	

	Address of Financial Institution		__________________________________________________________	

Driveways (For works on verge only) – For 2 unit developments

1.  The driveway of the original residences / units has not been changed and will service both residences / units. 

OR	
•	

	
You will need to provide a declaration stating that the driveway has not been changed since the Certificate of Occupancy or use was issued.  
(Declaration is required from the lessee)

2.  Construction of additional entrance

Modification of existing entrance

Relocation of existing entrance

Construction of two separate entrances

OR
	
•	
•	
•	
•	

You will need to provide a copy of the Verge/Driveway Inspection Certificate which is issued after an inspection of the form work for the driveway / verge/s by Asset Acceptance Section of Territory and Municipal Services
	
3.  Other (please specify)_________________________________________________________________

Use of the Land

Is the Use of the land consistent with the current purpose clause contained in the existing Crown lease?	•	YES 	•	NO	

Please specify which Zone in the Territory Plan applies to the 
block specified in this application: 	
		
(Please Note:  The Crown lease of all blocks falling under the Residential and Industrial Zones in the Territory Plan must specify the number of units.)

If the Crown lease specifies a maximum gross floor area for permissible uses, please allocate and advise below:

			
Does the term of the Crown lease exceed 50 years?	•	YES 	•	NO	
If no, you will need to apply for a further lease.

Is the block heritage listed?	•	YES 	•	NO	
If yes, your application will be referred to ACT Heritage.

Unit Title Assessment Report

Is a Unit Title Assessment Report for the land specified in this application attached?

The Unit Title Assessment Report includes the following documents:

Form 1A – Site Plan;
Form 1 – Surveyors Declaration;
Form 2 – Schedule of Unit Entitlement;
Form 3 – Floor Plan;
Certification of Unit Entitlements;
Certificate of Occupancy and Use;
Fitness for Unit Title Certificate;
Certification that no encroachment exists (if required);
Certification of encroachment over parcel boundary (if required); and
Any other further information obtained by the Unit Title Works Assessor.

	•	NO
•	YES	
Surveyor’s Checklist

Is a Surveyor’s Checklist for the land specified in this application attached?
	•	NO
•	YES	

Development Statement (for staged units only)

Is a Development Statement for the land specified in this application attached?
	•	NO
•	YES	

Asset Acceptance Certificate of Operational Acceptance

Is a Certificate of Operational Acceptance from Asset Acceptance for the land specified in this application attached?

NOTE: A Certificate of Operational Acceptance is obtained from the Asset Acceptance Section within the Department of Territory and Municipal Services.	•	NO
•	YES	

ActewAGL Certificate of Operational Acceptance

Is a Certificate of Operational Acceptance from ActewAGL for the land specified in this application attached?

NOTE: A Certificate of Operational Acceptance is obtained from ActewAGL. 
	•	NO
•	YES	

Crown Lease

Is the Crown Lease for the land specified in this application registered at the Land Titles Office?
	•	NO
•	YES	

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 Planning and Land Authority or Minister may revoke an approval if satisfied that the approval was obtained by fraud or misrepresentation.

Other Application for Unit Title Requirements

LODGEMENT & PAYMENT

A valid application for unit title comprises a completed application for unit title form accompanied by all of the required information or documents for it to be considered for approval.

Once an application for unit title is received, the documentation will be checked to ensure it meets the standard for lodgment.  If the documentation provided is acceptable, you will receive written confirmation the application is ready for lodgment and a request for the payment of the application fees. An application for unit title is not lodged until full payment of fees is made and receipted by EPD.

If the documentation is not acceptable for lodgment, you will receive written advice detailing the additional information required and/or any other issues with your application. Once these items are provided, EPD will recommence the documentation check and fee payment process outlined above.

DOCUMENTATION AND PLANS

All required documentation must be provided in hard copy.

Applicant and Lessee Declaration

I/we the undersigned, hereby apply for approval for unit title as described on the land 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 understand that the information submitted with this application form will undergo a documentation check prior to the payment of fees and formal lodgement of the application.  Further information may be required prior to the acceptance of the application for unit title by EPD.

I /we understand that this application will be considered lodged once the relevant application fees have been paid.

I/we understand that the documentation provided will be considered to be the relevant documentation associated with this application.

I/we understand that further information may be requested after the application for unit title is lodged with EPD.

I/we hereby authorise ACT Government officers to access the subject property(s) for the purpose of evaluating the proposal.

I/we the undersigned (lessee) appoint the applicant whose signature appears below to act on my/our behalf in relation to this application for unit title. This authorises the applicant to pay all application fees, bonds and securities, liaise with EPD when required, alter, amend or provide further information as necessary and receive any communications relating to this application for unit title.

I/we declare that all the 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		
				
1st Lessee’s Signature	
	Date		
				
2nd Lessee’s Signature	
	Date		

Privacy Notice
The personal information on this form is provided to the Environment and Planning Directorate (EPD) to enable the processing of your application. The collection of personal information is authorised by the Unit Titles Act 2001.  If all or some of the personal information is not collected EPD cannot process your application. The personal information you provide may be disclosed to Australian Bureau of Statistics, ACT Revenue Office, the Registrar General’s Office and other Government agencies with a direct interest in the Unit Title process.  The information may also be disclosed where authorised by law or court order, or where the Directorate reasonably believes that the use or disclosure of the information is reasonably necessary for enforcement-related activities conducted by, or on behalf of, an enforcement body. EPD’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by EPD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPD Information Privacy Policy can be found at www.environment@act.gov.au 

Contact Details:
Environment and Planning Directorate			
Customer Service Centres 				
GPO Box 158, Canberra City 2601 			
16 Challis Street Dickson ACT 2602
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays
Phone: (02) 6207 1923	TTY: (02) 6207 2622
Email: epdcustomerservices@act.gov.au	Website: www.environment@act.gov.au