The building and development provisions of your Crown lease may require that you complete building and development work within a stated period of time. A lessee may apply to the Environment and Planning Directorate to extend these provisions using this form. 

If you do not comply with your building and development provisions you will be conducting a controlled activity for failing to comply with a provision of the lease as per Schedule 2 of the Planning and Development Act 2007.

Please ensure ALL parts of the form are complete – failing to do so may result in additional administrative fees being payable
Please tick:
•	SALE	•	RESIDENTIAL	•	COMMERCIAL	•	DA CONDITION	

Lease/Site Details Please Print

Block	
		Section			Suburb		
	
Street Address 	

Applicant Details Please Print

Surname	
		First Name		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS

Lessee (Property Owners) Details Please Print

1st Lessee’s Details 
Surname	
		First Name		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

2nd Lessee’s Details (or Government Land Custodian)

Surname	
		First Name		
		
Postal Address	

Suburb	
		State			Postcode		
				
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

Lease Details (Please provide details if known) 

Insert Date – please print	
Lease grant/commencement date		
		
Date completion period expires		
		
Date facilities/associated works/other
 completion period expires		

Application for Extension of Time 

Please select the lease provisions you wish to extend and provide the new extended date you would like 
•	Completion	Extended Date:		
			
•	Facilities/associated works/other completion	Extended Date:		

Rates Assessment Notice

A current rates assessment notice is required to assess your application:

•	I have attached a copy of my annual rates assessment notice OR written advice from ACT Revenue indicating the annual rates payable for the block listed in this application (No additional fee payable)
•	I request EPD to seek the annual rates information from ACT Revenue on my behalf  (additional $78.00 fee applies)
Hardship and Fee Reduction

A fee reduction may apply to an extension of time application 

If you have read the Hardship provisions contained within the Planning and Development Act 2007 and Planning and Development Regulation 2008 and consider that one or more of the grounds outlined in this document apply to your application—and that you can provide suitable evidence—please provide this information with your application. 
•	I have enclosed a submission and evidence that I consider meets the requirements of the referenced legislation and would like this to be considered with my extension of time application. I accept this may increase the processing time of my request significantly. 
•	I do not want you to consider hardship or other grounds in my application.

Applicant/Lessee Declaration

I/we declare that all the information given on this form and its attachments is true and correct. I/we understand that the fees and charges apply to the submission of this application.
I/we authorise EPD to obtain a copy of and/or discuss any waiver or Act of Grace application with the Chief Minister, Treasury and Economic Development Directorate and/or contact the ACT Revenue Office for the purposes of obtaining rates information on my/our behalf.
If signing on behalf of a company, organisation or Government agency: -
I/we the undersigned, declare I/we have the appropriate delegation or authority to sign on behalf of the company, organisation or Government agency.

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 Planning and Development Act 2007.  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, ACTEW Corporation, ActewAGL, Territory and Municipal Services Directorate and other Government agencies with a direct interest in the development assessment and lease compliance 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 		Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays)
Customer Service Centres			Phone: (02) 6207 1923	TTY: (02) 6207 2622
GPO Box 158, Canberra City 2601 		Email: epdcustomerservices@act.gov.au	Website: www.environment@act.gov.au
8 Darling Street Mitchell, ACT 2911
16 Challis Street Dickson ACT 2602

DOCUMENTATION REQUIREMENTS CHECKLIST – the following documents must be supplied where relevant
Rates Assessment Notice	
A current rates assessment notice OR written advice from ACT Revenue indicating the annual rates payable for the block listed in this application must be provided with any application for the application to be assessed 	Annual rates assessment notice or advice from ACT Revenue supplied by applicant (No additional Fee)
EPD to seek advice from ACT Revenue (additional fee payable)	•	Supplied 	
Certificate of Occupancy and Use	
Provides evidence that building work is complete 	Full certificate of occupancy and use if issued 	•	Supplied 	
Operational acceptance (not required for single residential development)	
Demonstrates associated work is completed if a required clause of the Crown lease 	Certificate issued by Territory and Municipal Services for commencement of off site works 	•	Supplied 	
Hardship submission 	
Required if you believe that one or more of the grounds described in the Hardship provisions described under legislation apply and you would like us to consider this information with your application 	Statement describing why you believe one or more of the grounds described in the Hardship provisions under legislation apply to your lease 	•	Supplied 	

NOTE: Application fees for this application will vary depending on the type of lease and whether the building and development provisions have expired or not expired at the time the application fees are paid.  For more information go to the EPD Fees and Charges Guide available at www.environment.act.gov.au