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Declaration

Duties Form: Statement on Transfer of Dutiable Property under Part 3 of the Financial Sector (Transfers of Business) Act 1999

Fields marked with * are required

Collection statement

This information is collected by the SRO to evidence a transfer of property under Part 3 of the Financial Sector (Business Transfer and Group Restructure) Act 1999 (Cth). If you do not provide the information required, we may not be able to calculate the amount of duty payable. 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 on 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.

Signature

Date (DD/MM/YYYY)

First name

Middle name(s)

Family name

Position (if applicable)

Organisation (if applicable)

Mobile number

Phone number

Email

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

Australian Address

XMLAddress

XMLState

XMLPostCode

Transaction details

Duties Form: Statement on Transfer of Dutiable Property under Part 3 of the Financial Sector (Transfers of Business) Act 1999

Fields marked with * are required

Transaction details

I certify that

Full name of the receiving body to whom property is transferred under Part 3 of the Financial (Transfers of Business) Act 1999

ABN

ACN

became the receiving body of the property on date (DD/MM/YYYY)

Property details

Duties Form: Statement on Transfer of Dutiable Property under Part 3 of the Financial Sector (Transfers of Business) Act 1999

Fields marked with * are required

Property details

Please select the option that applies:

I have attached the section 19 statement referred to above

I have attached a schedule, providing details of the property being transferred including:
•in respect of transfers of real property, please show the Title particulars, being Volume/Folio numbers and Book/Numbers where applicable; and •in respect of transfers of unquoted marketable securities, including shares and units, please provide the entity’s name, quantity and class of marketable securities being transferred.

I believe this statement

is

is not

chargeable under chapter 4 of the Duties Act 2000.

This statement is exempt and satisfies the guidelines approved by the Minister for the following reasons: