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

APPLICATION FOR NAME SUPPRESSION
 IN THE LAND TITLES REGISTER	
Form 050 - NS	

	Land Titles Act 1925	

IMPORTANT INFORMATION

This form is to be used to lodge an application for name suppression in the land titles register under the Land Titles Act 1925 (the Act).  You can access the Act at www.legislation.act.gov.au or 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

•	The certificate of title is not required for lodgement of this document.
•	Only the Registered Proprietor can apply to have their name suppressed.
•	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.
•	Execution by:
a)	A Natural Person – Should be witnessed by an adult person who is not a party to the document.
b)	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 must state sole director.  (This execution does not require a witness).	

LODGEMENT AND CONTACT INFORMATION

Email:
actlandtitles@act.gov.au
General Enquiries: 
13 22 81 
	
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 FOR NAME SUPPRESSION
IN THE LAND TITLES REGISTER	
Form 050 - NS	

	Land Titles Act 1925	

Note – Suppression of the name will not prevent a person from accessing the register by using the parcel identifier of that land.

LODGING PARTY DETAILS	
Name	Email Address	Contact Telephone Number	
     	     	     	

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

FULL NAME AND ADDRESS OF THE REGISTERED PROPRIETOR (Surname Last) (ACN required for all companies)  	
     	

ACKNOWLDGEMENT	

I hereby apply to have access to my particulars restricted on searches by name, relating to the LTO records referenced in this application. 
In making this application I acknowledge that:
•	Name search suppression will not prevent my details from being discovered by other search methods (ie a search by street address) and;
•	It will be my responsibility to notify the Registrar-General if at any time in the future I acquire any additional property(s) and/or interest(s) in land in the Australian Capital Territory

EXECUTION	
Print full name of Registered Proprietor

     

Signature of Registered Proprietor 

Date -      	Print full name and address of witness 

     

Signature of witness

Date -      	

OFFICE USE ONLY	
PRIMARY IDENTIFICATION – (Minimum of one form of primary evidence required. One form of identification provided must be a government issued document containing a photograph and a signature.)	
Birth Certificate	State/Territory      
Number      	Australian Citizenship Certificate	Number      	
Passport	Country       
Number      			
SECONDARY IDENTIFICATION – (Two forms of secondary evidence required)	
Drivers Licence	State/Territory      
Number      	Medicare Card 	Number      
Expiry Date      	
Pension Card	Number      	Tax File Number Declaration	     	

Lodged by	Manager/Assistant Manager	Registered by		
Data entered by		Registration Date