Community Title Scheme please print

Community Title Scheme Number	

Developers / Body Corporate details please print

Surname	
		First name		
		
Company name	

Position held in company / body corporate			Australian Company/Business Number (ACN/ABN)		
		
Postal address	

Suburb	
		State			Postcode		
				
Phone number business hours			Mobile		
		
Email address	

Written Agreement of Persons with a Registered Interested 

Are there copies of the written agreement of each person with a registered interest in a lot
in the scheme for the land specified in this application attached?	•	NO
•	YES
	
Written Agreement of Prospective Owner’s 

Are there copies of the written agreement of each prospective owner of a lot in the scheme
for the land specified in this application attached?	•	NO
•	YES
	
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?	•	NO
•	YES
	
Conflict of Interest Declaration

Does the applicant, lessee or buyer have any association with EPD 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 Planning Minister may revoke an approval if satisfied that the approval was obtained by fraud or misrepresentation.
Description of Amendment to Community Title Scheme please print

Please tick one of these or a combination of these
•	How the staged development is to be carried out	•	Consequential amendments to the lot entitlement schedule	
•	Changes to the management statement	•	Changes to the master plan	
•	Other ________________________________________________________________________________	

Description of Amendments

Lots Affected please print

Note:  If there are more than three lots affected, by the amendments to 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	

Developer/Body Corporate declaration

I/we the undersigned, hereby apply to amend 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 body corporate:

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

Developer / Body Corporate 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