Pensioner Duty Concession Scheme Application Form
for transactions between 1 January 2010 and 30 June 2010

NOTES
•	Late applications will not be accepted.  An application must be received by the ACT Revenue Office within 90 days of the transaction date.  For an Off the Plan purchase or an Affordable House and Land Package it must be received within 1 year of the transaction date.  However, if one of the events happens under section 16A of the Duties Act 1999 the application must be received within 14 days of the event occurring. 
•	Transaction date is the date of grant/transfer or agreement for transfer (whichever is first).
•	To help determine if you qualify for a duty concession, please provide all details, ATTACH requested documents and tick the appropriate boxes.  Incomplete applications or applications lacking the required supporting information may result in the application being returned to you or the concession being denied. 
•	If there are more than two applicants, complete and attach a second application form.
•	Applying for a concession does not stop interest from being applied if payment of the required duty is made after the due date. 
Section 1	Applicant details	
Name of grantee/transferee	Marital status	Name of domestic partner (if any)	

Nominated contact (name)	Telephone (daytime)	Postal address	
			
Email address		
	Postcode	
Section 2	Eligible pensioner	
All transferees must be eligible pensioners.  At the date of the transaction, an eligible pensioner is a person in receipt of:
1.	an Australian age pension (Centrelink or Department of Veterans’ Affairs equivalent) and who holds a pensioner concession card—ATTACH copy; or
2.	a disability support pension and be 50 years of age or more and who holds a pensioner concession card—ATTACH copy and proof of age; or 
3.	Department of Veterans’ Affairs Gold Card for 1 year prior to the transaction—ATTACH copy.	
Section 3	Details of property applicant is purchasing	
Suburb	Section	Block	Unit	Purchase price 	Market value 	
				$	$	
Street address		
NOTE      If the buyer and seller are related parties, ATTACH a qualified valuer’s report to substantiate the current market value of the property.  Also ATTACH the original document/s for stamping.	
Is the property vacant land? 	YES	NO 	
Date of grant/transfer or agreement for transfer (whichever is first)	      /       /       	
What % of the property is being purchased?  	                   %	
Are all grantees and transferees together acquiring a legal and an equitable interest in the property? 	YES	NO 	

Section 4	Details of Australian property applicant is moving from	
Suburb	Section	Block	Unit	Actual or expected date of sale	
				        /       /       	
Street address		
Name of owners		
Section 5	Other interests in land	
At the date of the transaction (in Section 3), do any grantees/transferees or their domestic partners alone or jointly, hold a legal or equitable interest in land other than the subject property (in Section 3) and the property they are moving from (in Section 4)?  If YES provide details below.	YES 	NO 	
Suburb	Section	Block	Unit		
					
Street address		
Name of owners		
Section 6	Declaration and undertaking	
I/We declare that: 
1.	at least one applicant will reside in the home as their principal place of residence for a continuous period of 6 months and such period is to commence within 1 year of:
(a)	the date of completion of the eligible transaction for an eligible property; or
(b)	the date of the certificate of occupancy following completion of construction of the residence on the eligible vacant block;
2.	all of the information in this application, and in any supporting documentation, is true and correct and that to the best of my/our knowledge, no information relevant to the consideration of my/our application has been omitted.
I/We understand that:
1.	in the event that I am/we are granted a concession, the Commissioner for ACT Revenue may issue an amended assessment if it is determined that I/we did not meet the relevant criteria for the concession granted (e.g. not meeting the residency requirements); 
2.	depending on the circumstances, interest and penalties may be applied to any unpaid duty; and
3.	giving false or misleading information is a serious offence and the Criminal Code 2002 applies.	
Signature of all applicants
NOTE  
All grantees/transferees and domestic partners must sign	Signature:	Date:	
	Full name:		
	Signature:	Date:	
	Full name:		

GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (the Criminal Code 2002 applies)	
PRIVACY STATEMENT
All information collected by the ACT Revenue Office is protected by secrecy provisions in Acts administered by the Office and only used for the purposes of those Acts.  In addition, personal information provided to the ACT Revenue Office is protected by the Privacy Act 1988 (Cth).  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.