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Declaration

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Collection statement

This information is collected by the SRO to assist the Commissioner of State Revenue and the Land Tax Hardship Relief Board consider your application for the remission or postponement of your land tax liability. The information collected is protected by the secrecy provisions in Acts administered by the SRO and in addition, personal information you provide to the SRO is protected by the Privacy and Data Protection Act 2014. Where authorised by law to do so, we may 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

Applicant details

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Type of entity

Is the taxpayer a company?
Company details
List all current shareholders and the number of shares each shareholder holds. Attach copies of:
• The latest detailed financial statements (including balance sheet and profit and loss statements) of the company, and
• Details of current cash flows.

Shareholder

Shareholder name

Assessment details

Assessment number

Grounds for relief

Applicant details

I,
Name of applicant
of
Postal Address

Australian address

What is the type of address?

International address

apply for relief from the payment of Land Tax for a person in serious hardship under section 91, section 92 or section 93 of the Land Tax Act 2005. I supply the following information in support of my application.
Do you have a partner/spouse?

Employment or business income

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Employment details

Note: Attach copies of your income tax return including the notice of assessment (excluding the tax file number).
Your details
Are you currently employed or have been employed in the past 12 months?
Postal address of most recent employer

Australian address

What is the type of address?

International address

Your partner's details
Is your partner currently employed or been employed in the past 12 months?
Postal address of most recent employer

Australian address

What is the type of address?

International address

Business details

Note: Attach copies of you and/or your partner’s business income tax returns including the notice of assessments and the company's financial statements.
Your details
Are you self-employed, the owner or part-owner of a business?
Postal address of business

Australian address

What is the type of address?

International address

Your partner's details
Is your partner self-employed, the owner or part-owner of a business (including a farm)?
Postal address of business

Australian address

What is the type of address?

International address

Other incomes

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Superannuation or other pensions, and other income

Note: Other income means income from any other source apart from that already disclosed, including:
Superannuation pension/annuity,Income from boarders or lodgers,Overseas pension,Rental income,Compensation or retiring allowance,Austudy, other educational assistance or allowance,Income from any other government departmentMaintenance payments for you or children in your care
Your details
Do you receive or are you entitled to receive superannuation or other pensions and other income (apart from employment)?

Income

Your partner's details
Does your partner receive or are they entitled to receive superannuation or other pensions and other income (apart from employment)?

Income

Assets

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Superannuation and rollover investments

Investments to be included here are investments in:
• Approved deposit funds or deferred annuities, and
• Superannuation funds where you do not receive a superannuation pension from the fund
Your details
Do you have any money invested in approved deposit funds, deferred annuities or superannuation funds?

Investment

Your partner's details
Does you partner have any money invested in approved deposit funds, deferred annuities or superannuation funds?

Investment

Have you and/or your partner made any withdrawals from a deferred annuity or approved deposit fund? (This includes both partial withdrawals and where the full amount of the investment was withdrawn.)
Do not include transfers to other deferred annuities, approved deposit funds or superannuation funds.
Please provide documents relating to the withdrawals.

Real estate

Provide details of any real estate owned by you and/or your partner.

Real estate includes vacant land, retail, industrial or commercial premises, house or townhouse, self-contained flat, units or flats, market garden, farm or hobby farm and overseas property.
If the property is a farm, include the value of livestock, plant and machinery in estimating market value.
Your details
Do you own any real estate?

Real estate

Your partner's details
Does your partner own any real estate?

Real estate

Shares

Provide details of any shares, options, rights, convertible notes or other securities that you and/or your partner own, listed on the Australian or other stock exchanges or issued by a private or public company not listed on a stock exchange. If there is insufficient space, please attach additional information.
Your details
Do you own any shares, options, rights, convertible notes or other securities?

Company

Your partner's details
Does your partner own any shares, options, rights, convertible notes or other securities?

Company

Government bonds, unsecured notes, money on loan

Note: All loans should be included, whether they are made to family members, other people, organisations or trusts.
Do you and/or your partner hold any government bonds, debentures, unsecured notes or loans?

Investment

Motor vehicles

Your details
Do you own, partly own or have an interest in any motor vehicles, trailers, boats or caravans?

Motor vehicle

Your partner's details
Does your partner own, partly own or have an interest in any motor vehicles, boats or caravans?

Motor vehicle

Other assets

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Other assets

Your details
Do you have any other assets not shown on this form (for example, house contents)?

Asset

Your partner's details
Does your partner have any other assets not shown on this form (for example, house contents)?

Asset

Gifts and sales of assets

Your details
Have you gifted or sold any property or assets in the past 12 months?

Asset

Name and address of the person you sold or gave the item to

Australian address

What is the type of address?

International address

Your partner's details
Has your partner gifted or sold any property or assets in the past 12 months?

Asset

Name and address of the person you sold or gave the item to

Australian address

What is the type of address?

International address

Debts

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Debts

Provide details of any other debts (that is, credit cards, hire purchase agreements, personal loans) you and/or your partner have.
Do you and/or your partner have any other debts?

Debt

Dependants

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Dependants

Do you and/or your partner have any dependants?
Provide the names and ages of all persons dependant on you and/or your partner

Dependant

Document checklist

Application for Remission or Postponement of Payment of Land Tax Due to Serious Financial Hardship
Fields marked with * are required

Document checklist

To support your application, you should upload relevant information and documentation.

Supporting documents

Supporting document

Supporting document
File: