PLEASE NOTE:
This application is for approval to payout the land rent on both Residential Land Rent Scheme Crown leases and all other land rent Crown leases eligible to payout the land rent in accordance with Disallowable Instrument No 2009-162.

Disallowable Instrument No 2009-162 provides for the Lessee, where applying to payout the Residential Land Rent Scheme, to pay either the unimproved value on the current Valuation Notice OR the current market value as prepared by a member of the Australian Property Institute. 

Disallowable Instrument No 2009-162 requires the Lessee, where applying to payout the land rent for other than Residential Land Rent Scheme Crown leases, to provide a valuation report prepared by a member of the Australian Property Institute. 

Lease details please print

Block/s	
	Section 		Suburb		Unit No.		

Street Address	

Important Information

•	The ‘applicant’ is the person who will be contacted in relation to the Land Rent Payout Application. 
•	The new non-rental Crown Lease will only be issued in the name/s that appear on the current Certificate of Title.
•	Settlement cannot be less than 4 weeks from EPD receiving payment and all relevant documentation in relation to this application. Please note that settlements only occur on Wednesdays. 
•	Payout Figures (Rates, Land Rent and Land Tax) must be paid up to and including the settlement date. The applicant will be notified of any outstanding amounts owing prior to settlement. 
•	Residential - If the dwelling is built, it is mandatory to obtain a Certificate of Compliance.  
o	Please note that a Certificate of Occupancy and Use is not the same as a Certificate of Compliance.
o	A Certificate of Occupancy and Use is issued prior to a Certificate of Compliance. 
•	If the building works on the block haven’t started you may need to apply for an Extension of Time (EOT) to extend your building covenants. 

Applicant details please print

Surname	
		First name		
		
Company name	

Postal address	

Phone number business hours			Mobile		
		
Email address

Lessee (property owners) details please print

First lessee’s details

Surname	
		First name		
		
Company name	

Position held in company			Australian Company Number (ACN)		
		
Street address
(not PO Box)	

Phone number business hours			Mobile		
		
Email address	

Second lessee’s details

Surname	
		First name		
		
Company name	

Position held in company			Australian Company Number (ACN)		
		
Street address
(not PO Box)	

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.

Documentation Requirements

If the application relates to a Registered Units Plan you are required to provide the following documents

Unopposed Resolution

Is an unopposed resolution of the Owners Corporation attached?	•	YES	•	NO	
Building Status

If the building is complete, has a Certificate of Compliance been granted?	•	YES	•	NO	•	N/A

If paying the unimproved value on the current Valuation Notice for a Residential Land Rent Scheme Crown lease, you are required to provide a VALUATION NOTICE:

Is a current Valuation Notice (issued by the ACT Revenue Office) attached?	•	YES	•	NO	

If paying the current market value as prepared by a member of the Australian Property Institute for a Residential Land Rent Scheme Crown lease OR for all other land rent Crown lease payouts, you are required to provide the CURRENT MARKET VALUE REPORT:

Is a valuation report of the current market value of the land dated no later than 2 weeks before
the date of lodgement of this application attached?	•	YES	•	NO	

Conflict of Interest Declaration

Does the applicant 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.

Applicant, Lessee declaration

I/we the undersigned, hereby apply to payout the land rent payable on the lease specified in this application and declare that this application is accompanied by all of the required information or documents for it to be considered for approval.

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

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 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		
				
First lessee signature	
	Date		
				
Second lessee signature	
	Date		

Privacy Notice
The personal information on this form is being collected to enable processing of your application. Collection of personal information is authorised by Chapters 7, 8 and 9 of the Planning and Development Act 2007. The information that you provide may be disclosed to the ACT Revenue Office, the Australian Valuation Office and the Registrar-General’s Office. The information may be accessed by other government agencies, ACTEWAGL, ACTEW Corporation and other commercial organisations interested in development and building information. 
Contact Details:
Environment, Planning and Sustainable Development Directorate
Customer Service Centre
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
Email: epdcustomerservices@act.gov.au	Website: www.planning.act.gov.au