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Canberra ACT 2601 Phone: (02) 6205 0600 Fax: (02) 6207 5101 Email: lda@act.gov.au Web: www.lda.act.gov.au
What is the definition of a Related Party? Where you are a person, a Related Party to you is: your spouse or domestic partner; a company of which you are a director or secretary; or a company of which your spouse or domestic partner is a director or secretary. your director or secretary; a person who is a spouse or domestic partner of your director or secretary; a company where your director or secretary is also a director or secretary of that company; or a company where your director or secretary is a spouse or domestic partner of a director or secretary of that company.
Acceptance or rejection of Application This Application will be assessed in accordance with the conditions and requirements advertised for this sales process and may be rejected if: (a) acceptance of the Application for Land Rent Lease may result in you or a Related Party to you having more than five (5) blocks On Hold for Land Rent Leases; or (b) the Application for Land Rend Lease has not been fully completed or executed to the satisfaction of the LDA; or (c) you have made a false declaration in the Application for Land Rent Lease; or (d) you have not paid any applicable fee; (e) the LDA has not invited applications for the right to the grant of a Land Rent lease for the Block; or (f) the Application for Land Rent Lease does not otherwise comply with any of the conditions or requirements advertised for this sales process (applicable conditions). Application Fee An Application Fee of $1,000 per block is only payable by you where you or a Related Party already have a block On Hold as defined in the applicable conditions and this Application for Land Rent Lease. This Application Fee: (a) is non refundable if the Application for Land Rent Lease is accepted by the LDA and you enter into a First Grant Contract irrespective of whether you change your election to purchase the right to the grant of a Standard Lease before or after exchange of First Grant Contract;
Further information For further information in relation to the hold of the Block, attendance at the CIT course or any other matters associated with the Land Rent Scheme, please refer to www.economicdevelopment.act.gov.au/ affordable_housing/land_rent or email land.rent@act.gov.au
ACN Address State Postal address As above Phone (BH) Mobile Email address State Phone (AH) Postcode Postcode
Applicant 2 (if applicable) Title First name Middle name Last name Company name
(to be completed if purchasing as a company)
Postcode
Postcode
Email address
continued
If Yes, please provide Block, Section and Estate details and the name of the purchasing entity. See page 1 for Application Fee and circumstances where the Application may be rejected.
Statutory Declaration Applicant 1 I, (full name) being a (occupation) of (address) make the following declarations under the Statutory Declarations Act 1959 (Cth): 1. the Applicant(s) listed in this form apply to the LDA to enter into a First Grant Contract for the right to the grant of a Land Rent Lease; 2. I have read all information provided in the applicable conditions including all pages of this Application for Land Rent Lease thoroughly; and 3. the information provided by me in this Application for Land Rent Lease is true and correct to the best of my knowledge and belief. I understand that a person who intentionally makes a false declaration in a statutory declaration is guilty of an offence under Section 11 of the Statutory Declarations Act 1959 (Cth), and I believe that the statements in this declaration are true in every particular. Signed (Applicant 1 signature) Declared at (place) On (date) D D Before me (signature of witness) Full name of witness Qualifications of witness (See authorised
witness list on page 4)
M M
On (date) D D
M M
Other persons: A gent 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 five (5) or more continuous years of service Building society officer with five (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 five (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
LDA 2012/02