Australian Capital Territory
Building Act (Application form for fidelity fund scheme) Determination 2002
Disallowable instrument DI2002—50
made under the
Approval Criteria cl2 (Application for approval of a fidelity fund scheme) made under the Building Act 1972 s58K (Approval criteria for fidelity fund schemes)

I determine the form set out in the schedule to this instrument to be the form that must be used in an application for the approval of a fidelity fund scheme.

Simon Corbell
Minister for Planning
23 May 2002

 ACT Government

Application for approval of a fidelity fund scheme
Building Act 1972

Part 1: Applicant details
Name		

Planning and Land Management
Operational address		
		
Service address		
		
Telephone		
		
Fax		
		
Contact person		
		
Part 2: Fidelity fund details
Attach	A copy of the executed fidelity fund trust deed		
	that complies with clause 3 of the approval criteria 		

	Information showing that the trust deed complies with 		
	clauses 4 to 8 of the approval criteria 		

	Information showing that the fidelity fund scheme complies 		
	with clause 14 of the approval criteria 		

	Information showing that the fidelity fund scheme complies 		
	with any determination under clause 12 of the approval criteria		
		
Part 3: Trustee details
Attach	Contact details for each trustee of the fidelity fund		

	Information showing that each trustee complies with 		
	clause 11 of the approval criteria 		

Part 4: Trustees’ signatures
Signature		Date	........./............/..........	
				
Trustee’s name		
		
Signature		Date	........./.........../...........	
				
Trustee’s name		
		
Signature		Date	........./.........../...........	
				
Trustee’s name		
		
Signature		Date	........./.........../...........	
				
Trustee’s name		
		
Signature		Date	........./............/..........	
		
Trustee’s name		
 Approval or refusal (for government use only)
Approval of this application	Is recommended		Is not recommended		

	Is recommended with conditions (attached)		

	Is not recommended unless it is changed		

Signature		Date	........./............/..........	
				
Recommending officer		
		
Decision	Approved / Refused / Approved as modified / Refused but would be acceptable with changes	
		
		Date	........./............/..........	
				
	Simon Corbell 	Minister for Planning