LAND TITLES
ACCESS CANBERRA
Chief Minister, Treasury and Economic Development Directorate

APPLICATION TO CORRECT THE REGISTER	
Form 004 - CR	

	Land Titles Act 1925	

IMPORTANT INFORMATION
This form is to be used to lodge an application to correct the register under the Land Titles Act 1925 (the Act).  You can access the Act at www.legislation.act.gov.au. You may also obtain further information and forms at www.act.gov.au/accesscbr.
	
PRIVACY INFORMATION
The Act authorises the Registrar-General to collect the personal information required by this form for the purposes of issuing a registration under the Act.  The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Information Privacy Act 2014. The Registrar-General provides identifiable information to law enforcement and other Directorates that have legal authority to request information under prescribed circumstances.
These agencies may also use this information to prepare and sell property sales reports to commercial organisations concerned with the development, sale or marketing of land.
	
INSTRUCTIONS FOR COMPLETION
•	Satisfactory evidence in support of this application must be provided to the Registrar-General.
•	The certificate of title or production of title consenting to the registration of this document is required for lodgement.
•	All information should be typed or clearly printed.  If completing this form by hand please use a solid black pen only.  
•	This office will not accept lodgement of this form if it is not completed in full.
•	Any alteration to information provided on this form must be struck through with a black pen.  Substitute information must be clear and all parties must sign in the margin.  Do not use correction fluid or tape.
•	Ensure all required documents are attached.  If there is insufficient space in any panel, please use an Annexure Sheet.
•	One form of Primary Identification – Original or Certified Copy of Birth Certificate, Citizenship Certificate or Passport
•	One form of Secondary Identification – Original or Certified Copy of Drivers Licence, Medicare Card, Pension Card or Tax File Number Declaration issued by the Australian Taxation Office.
•	Execution by:
a)	A Natural Person – Should be witnessed by an adult person who is not a party to the document.
b)	Attorney – if this document is executed by an Attorney pursuant to a registered power of attorney, it must set out the full name of the attorney and the form of execution must indicate the source of his/her authority e.g. “AB by his/her attorney XY pursuant to Power of Attorney ACT Registration No…… of which he/she has no notice of revocation”.  (This execution requires a witness).
c)	Corporation – Section 127 of the Corporations Act provides that a company may now validly execute a document with or without using a Common Seal if the document is signed by:
i.	Two directors of the company;
ii.	A director and a secretary of the company; or
iii.	Where the company is a proprietary company and has a sole director who is also the sole company secretary, that director. (No witness is required for this execution).

LODGEMENT AND CONTACT INFORMATION	

Email:
actlandtitles@act.gov.au
General Enquiries: 
(02) 6207 3000 	
In Person:
Environment, Planning and Land Shopfront
Ground Floor South, Dame Pattie Menzies House, 16 Challis Street, Dickson
Opening hours - Monday to Friday 8:30am to 4:30pm (excluding public holidays)	

	LAND TITLES
ACCESS CANBERRA
Chief Minister, Treasury and Economic Development Directorate

APPLICATION TO CORRECT THE REGISTER	
Form 004 - CR	

	Land Titles Act 1925	

LODGING PARTY DETAILS	
Name	Postal Address	Contact Telephone Number	
     	     	     	

TITLE AND LAND DETAILS	
Volume & Folio	District/Division	Section	Block	Unit	
     	     	     	     	     	

APPLICANT/S (Provide Full Name, Surname Last)	FULL POSTAL ADDRESS (including postcode)	
     	     	

CAPACITY OF APPLICANT/S (tick whichever is applicable)	

 Registered Proprietor/s       or         Legal Practitioner        or         Mortgagee in Mortgage No

 Executor                                  or        Other (please state)

NAME AND ADDRESS OF REGISTERED PROPRIETOR/S (Complete where the Applicant is NOT a registered proprietor)	
     	

REASON FOR CORRECTION (Please provide clear instructions/details as to the proposed correction to the register)	
(This section should include – What the error is, how and when the error occurred, who made the error and what needs to be done to fix the error)
     	

SUPPORTING DOCUMENTS (the following documents are required in support of this application)	

 Statutory Declaration/s (from all parties affected by the correction)

 Contract for Sale (if required)

 Other (please specify)

DATE	
     	

CONSENT 	

Print full name of person consenting and the capacity under which consenting (eg, Registered Proprietor)

     

Signature or common seal of Consenting Party
	
Print full name and address of witness 

     

Signature of witness

APPLICANT’S EXECUTION	

Print full name of Applicant 

     

Signature or common seal of Applicant
	
Print full name and address of witness 

     

Signature of witness

OFFICE USE ONLY	
Lodged by		Certificate of title lodged		
Birth Certificate/Passport		Drivers Licence		
Citizenship Certificate		Medicare/Pension Card No.		
Data entered by		Certificates attached to title		
Registered by		Attachments / Annexures		
Registration date		Production number		

Commonwealth of Australia
STATUTORY DECLARATION
Statutory Declarations Act 1959

1	Insert the name, address and occupation of person making the declaration	
I/We,1

make the following declaration under the Statutory Declarations Act 1959:	

2	Set out matter declared to in numbered paragraphs

3 Signature of person making the declaration
	
2

I/We understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.

	
4	Place
5	Day
6	Month and year

7  Signature of
person before
whom the
declaration is
made (see over)

8  Full name,
qualification and
address of person
before whom the
declaration is
made (in printed
letters)	Declared at: .................................................... on ........................................................................ 
[place]                                                               [date]

in the presence of an authorised witness, who states:

I, ...................................................................... , a .......................................................................,
[name of authorised witness] [qualification of authorised witness]

certify the following matters concerning the making of this statutory declaration by the person who made it:
 [* please cross out any text that does not apply]

1. *I saw the face of the person OR *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering, and

2. *I have known the person for at least 12 months OR *I have confirmed the person’s identity using an
identification document and the document I relied on was …………...………………………………….
[describe identification document relied on]

.................................................................    ...........................              ..................................................................
[Name and signature of authorised witness] [date] [address of the authorised witness]
	
A statutory declaration under the Statutory Declarations Act 1959 may be made before–
(1) a person who is currently licensed or registered under a law to practise in one of the following occupations:
Chiropractor		Dentist			Legal practitioner
Medical practitioner		Nurse			Optometrist
Patent attorney		Pharmacist			Physiotherapist
Psychologist		Trademarks attorney		Veterinary surgeon
(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); or
(3) a person who is in the following list:
Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public
Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)
Bailiff
Bank officer with 5 or more continuous years of service
Building society officer with 5 or more years of continuous service
Chief executive officer of a Commonwealth court
Clerk of a court
Commissioner for Affidavits
Commissioner for Declarations
Credit union officer with 5 or more years of continuous service
Employee of the Australian Trade Commission who is:
(a) in a country or place outside Australia; and
(b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and
(c) exercising his or her function in that place
Employee of the Commonwealth who is:
(a) in a country or place outside Australia; and
(b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and
(c) exercising his or her function in that place
Fellow of the National Tax Accountants’ Association
Finance company officer with 5 or more years of continuous service
Holder of a statutory office not specified in another item in this list
Judge of a court
Justice of the Peace
Magistrate
Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961
Master of a court
Member of Chartered Secretaries Australia
Member of Engineers Australia, other than at the grade of student
Member of the Association of Taxation and Management Accountants
Member of the Australasian Institute of Mining and Metallurgy
Member of the Australian Defence Force who is:
(a) an officer; or
(b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or
(c) a warrant officer within the meaning of that Act
Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants
Member of:
(a) the Parliament of the Commonwealth; or
(b) the Parliament of a State; or
(c) a Territory legislature; or
(d) a local government authority of a State or Territory
Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961
Notary public
Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public
Permanent employee of:
(a) the Commonwealth or a Commonwealth authority; or
(b) a State or Territory or a State or Territory authority; or
(c) a local government authority;
with 5 or more years of continuous service who is not specified in another item in this list
Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made
Police officer
Registrar, or Deputy Registrar, of a court
Senior Executive Service employee of:
(a) the Commonwealth or a Commonwealth authority; or
(b) a State or Territory or a State or Territory authority
Sheriff
Sheriff’s officer
Teacher employed on a full-time basis at a school or tertiary education institution