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Declaration

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Receipt details

Your form has been successfully submitted. Please keep a copy of this acknowledgement for your records.

Reference number:

When contacting the State Revenue Office in relation to this application, please quote this Reference number.

Submission date and time:

To save or print a copy of the completed form and acknowledgement go to the "File" menu and select "Save as" or "Print".

Collection statement

This information is collected by the SRO to help us determine whether a GAIC liability exists on certain land which is subject to building permit application. Failure to provide the information requested, is in breach of the Building Act 1993. The information collected may be used for the purposes of other SRO legislation. Where authorised by law to do so, we may also disclose this information to other government agencies including the ATO, State and Territory revenue offices and law enforcement agencies. You can find out more about how we use and protect your information in our Privacy Policy, available at www.sro.vic.gov.au.

Declaration

I declare that I am authorised to make this declaration.

The information provided on this form and in any attached documents is complete and correct. I understand that penalties apply for giving false or misleading information or omitting information.

The Electronic Transactions (Victoria) Act 2000 establishes the regulatory framework for transactions to be completed electronically. This form requires you to complete an electronic signature via tick-box before lodgment. By ticking the box you indicate your approval of the contents of this electronic communication.

Date

Signature

Date (DD/MM/YYYY)

First name

Middle name(s)

Family name

Position (if applicable)

Organisation (if applicable)

Mobile number

Phone number

Email

Applicant

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Is the application in relation to a business entity?

Individual

Business

Individual

Title

Other

First name

Middle name(s)

Family name

Business

Name of company

Trading name (if different from company name)

ABN

ACN

Postal address

Country

Australian address

What is the type of address?

Street

PO Box

Lot number

Floor/Level type

Floor number

Flat/Unit type

Unit number

PO Box number

Post office name

Lot number

Street number

Street name

Street type

Suburb/Town

State

Postcode

International address

Street address/Postal address

Suburb/Town

State

Postcode/Zipcode

Overseas Address

Contact

Mobile number

Phone number

Email

Permit application details

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Details of the land

Land

This information can be found on the Certificate of Title.

What is the type of address?

Street

Lot number

Floor/Level type

Floor number

Flat/Unit type

Unit number

Lot number

Street number

Street name

Street type

Suburb/Town

State

Postcode

Title

Volume

Folio

Lot

Plan

Plan type

Area of land (in hectares)

Municipality

Municipality property number

Other municipality

Section or portion number

Crown allotment

Parish / Township name

Ownership details

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Is the applicant for the building permit the registered owner of the land?

Yes

No

Land owner

The land is owned by:

an individual

a company/business entity

the Crown

a public authority

Individual

Title

Other

First name

Middle name(s)

Family name

Business

Name of company

Trading name (if different from company name)

ABN

ACN

Contact

Mobile number

Phone number

Email

Lodging party details

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Business

Building surveyor

Name of company

Trading name (if different from company name)

ABN

ACN

Postal address

Country

Australian address

What is the type of address?

Street

PO Box

Lot number

Floor/Level type

Floor number

Flat/Unit type

Unit number

PO Box number

Post office name

Lot number

Street number

Street name

Street type

Suburb/Town

State

Postcode

International address

Street address/Postal address

Suburb/Town

State

Postcode/Zipcode

Overseas Address

Contact

Mobile number

Phone number

Email

Building permit application details

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Application date

Date the building application was received:

Date (DD/MM/YYY)

Nature of building work

What is the nature of the building work?

Construction of new building

Extension to an existing building

Alteration to an existing building

Change of use of an existing building

Other

Please describe the nature of the building work

What is the proposed use of the building?

Cost of building work

Is there a contract for the building work?

Yes

No

What is the estimated cost of the building work? (Please include cost of labour and materials, and attach details of the method of estimation)

What is the contract price?

Stage of building work

Is the application to permit a stage of the work?

Yes

No

What is the extent of work in the stage?

What is the cost of the work for this stage?

Supporting documentation

GAIC: Notification of a Building Permit Application

Fields marked with * are required

Supporting documents

Please provide documentation to support your GAIC application

File: