Lots to be included in the Community Title Scheme please print

Note:  If there are more than three lots in 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	

Developers details please print

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	

Lessee (owners) details please print

Note:  If the lessee is the developer, write “see developer’s details”

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	

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.

Master Plan

Is a master plan for the land specified in this application attached?	•	YES	•	NO 	

Management Statement 

Is a management statement for the land specified in this application attached	•	YES	•	NO 	

Constituent Documents for the Body Corporate

Are the constituent documents for the body corporate to be formed
on registration for the land specified in this application attached?	•	YES	•	NO 	

By-Laws of the Body Corporate	

Are the by-laws of the body corporate for the land specified in this application attached?	•	YES	•	NO 	

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?	•	YES	•	NO 	

Form 2 – Requirements & Checklist

Is Form 2 – Requirements and Checklist for the land specified in this application attached?	•	YES	•	NO 	

Conflict of interest declaration

Does the developer or lessee have any association with EPD staff?          	•	YES	•	NO 	

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.

Scheme details please print

Please provide a brief description of the type of community title scheme you are applying for:

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

		
Type of Scheme

(please tick one of these or a combination of these)
•	COMMERCIAL	•	RESIDENTAIL	•	INDUSTRIAL	•	UN-STAGED	
				
•	STAGED  - A bond may be required to provide security for a staged development	
	(If more than 3 stages, please provide details separately)

Cost of total development	$ ___________________

Cost of stage 1	$ ___________________

Cost of stage 2	$ ___________________

Cost of stage 3	$ ___________________

Does the proposed community title scheme include any of the following:

•	Unit Title	•	Partly Developed Land	•	Development Application	
•	Undeveloped Land	•	Fully Developed Land		

Developer’s & Lessee’s declaration

I/we the undersigned, hereby apply for approval of 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 organization:

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

Developer’s  signature	
	Date		
				
First lessee’s signature	
	Date		
				
Second 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 Community Title 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.planning@act.gov.au

Contact Details:
Environment and Planning Directorate
Customer Service Centres 
GPO Box 158, Canberra City 2601 
8 Darling Street Mitchell, ACT 2911
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.planning@act.gov.au