Form: 12PV Licence: 98M 111 Edition: 0308

APPLICATION FOR NEW CERTIFICATE OF TITLE

Leave this space clear. Affix additional pages to the top left-hand corner.

Ne w S o u t h W al es ss 38 (2) & 11 1 Re al P roper t y A c t 1 90 0 PRI V A C Y N O T E : S ec ti on 31B o f the Re a l P roper t y A c t 1 9 00 (R P A c t ) authorise s the Re gis tr a r Ge ne r al t o c oll ec t the infor m a ti on re qui re d b y this f o rm f o r the es ta bl is hm e nt a nd m ai nte na nc e o f the Re a l P roper t y A c t R e gis ter. Sec ti on 96B R P A c t re qui re s tha t the R e gis ter is m a de a v a il a b l e t o a ny pe r s o n f o r se ar c h u p o n pay m e nt o f a fee , i f any. (A) T O R R E N S T IT L E Nu mber of the cert ificate of title mislaid, destroyed, stolen, damaged or part ly destroyed

<<Sell|Forms|Title Reference/Folio Identifier>>

(B) L OD G E D B Y Delivery Box Name, Address or DX and Telephone C O DES

<<Sell|Forms|Lodgement Party>> <<Sell|Our Reference>>

PV R

Reference (optional): (C) R E G IS T E R E D PR O P R IE T O R (D) A P P L I C A N T

Insert the names of all the registered proprietors

<<Sell|Forms|Registered Proprietor>>

W AR N IN G ! SE V ER E P ENAL T IE S M A Y BE IM P O S E D F O R L O D G ING A FAL SE A P PL ICA T IO N

(E) The certificate of title referred to above has been i. mis laid ii. destroyed iii. stolen iv. damaged such that the folio identifier / vo lu me and folio nu mber cannot be read. [If it can be read, do not use this form. Complete Request form 11R and attach the damaged certificate.] In consequence I apply for issue of a replacement, and certify this application correct for the purposes of the Real Property Act 1900. DATE (F)
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dd mm yyyy I cert ify th at the app lican t, with who m I am p ersonally acquainted or as to whose identity I am otherwise satisfied, signed this application in my presence. Signature of witness: Name of witness: Address of witness: Daytime telephone number of witness: NB: The witness may be contact ed by the Department of Lands to verify the signing.

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Cert ified co rrect for the pu rposes of the Real Property Act 1900 by the applicant. Signature of applicant:

PL EASE NO T E
1. 2. 3. 4. T hi s a ppli c a ti on w i ll n o t be a cc e pte d t h r o u g h the pos t. I t m ust be l odge d b y h a n d a t the D e par tm e nt o f L a n d s , L a n d a nd Pr ope r t y I nfor m a ti on D i v is i on. A r e pl a ce m e nt c er ti fi c a te o f ti tl e w i l l n o t be is s ued unti l LPI D i vi si on c om pl e tes i ts i nv es ti ga ti on. If the ev i de nce f u rni s he d at l odgm e nt (s e e N o . 7 i n I ns tr u c t i o n s fo r C om ple ti on) i s i ns uf fi c ie nt fo r LPI Di vi si on t o ful l y i nv e s ti ga te the a ppl i c a ti on, f u r ther e vi de nce w i l l be r e qui r e d. In the ca se o f a n a ppl ic a ti on l odge d b y a pr iv a te per s o n i n re g a r d t o a ce r ti fi c a te o f ti tl e m i s l a i d, des tr o y e d o r s tole n: T h e r e pla ce m e nt cer ti fic a te o f ti tle w i ll be p o s t e d b y r e gis ter ed m a i l t o the a ppli ca nt a t the a ddr e s s f o r se r v ice o f notice s h o w n o n the r ate notic e (se e N o. 7 i n In s t r u c t i o n s f o r C om ple ti on). The p e rs o n acc epti ng i t w i ll be r e quir e d b y A u s t ra l i a P o s t t o si gn a r ec ei pt. I f the a dd r e s s f o r se r vi ce o f notice s h o w n o n the ra te notic e has c ha nge d si nce the ra te notice was is s ue d, full de tail s of the c ha nge must be i ncl ude d i n the a pplic a nts s t at u t o r y dec la r a ti on. NB: Fo r dire cti ons o n c om ple ti ng and l odgi ng this a ppl ica ti on a nd detail s o f the evi de nc e w hic h m u s t a cc om pa ny the a ppli ca ti on, see the acc om pa nyi ng In s t r u c t i o n s f o r C om pl eti on. A set of instruct ions fo r co mpleting th is fo rm is available fro m the Depart ment of Lands, Land and Prop erty In fo rmat ion Div is ion .

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H A N D W R IT I N G M U S T B E IN B L O C K C A P IT A L S .

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