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[LAS 10,150] SCHEDULE 1 (Regulation 5(2)) LAND SALES ACT 1974REVIEW COMMITTEE APPLICATION FORM
| A. | APPLICANT’S DETAILS | ||
| 1. | Please fill in paragraph 1A if the applicant is an individual. If otherwise, please skip to paragraph 1B. | ||
| 1A. | Applicant is an individual: | ||
| (a) | Name: ‥ | ||
| [Title] [first name] [middle name] [surname] | |||
| (b) | Residential address: ‥ | ||
| (c) | Physical Address: ‥ | ||
| (d) | Telephone: ‥ | ||
| (e) | Fax: ‥ | ||
| (f) | E-mail: ‥ | ||
| (g) | Passport number: ‥ | ||
| [Please annex certified copy of passport bio-data] | |||
| (h) | Does the applicant hold dual or multiple citizenship? | ||
| □ Yes | □ No | ||
| (i) | If you have ticked yes in subparagraph (h), list passports held. | ||
| Country: ‥ | Passport No: ‥ | ||
| Country: ‥ | Passport No: ‥ | ||
| Country: ‥ | Passport No: ‥ | ||
| [Please annex certified copy of passport bio-data for each passport] | |||
| (j) | Please list the applicant’s total annual income for each of the preceding 3 years. | ||
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| (k) | If residing in Fiji, list reason(s) for residing in Fiji. | ||
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| 1B. | Applicant is a company: | ||||
| (a) | Company name: ‥ | ||||
| (b) | Company number (if applicable): ‥ | ||||
| (c) | Director(s): ‥ | ||||
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| (d) | Country of incorporation: ‥ | ||||
| (e) | Shareholders: | ||||
| Name | Citizenship(s) | Shares held | |||
| [Please annex corporate diagram] | |||||
| (f) | Please list consolidated revenue for each of the preceding 3 financial years. | ||||
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| [Please annex financial statements for each of the preceding 3 financial years (audited, if available)] | |||||
| (g) | Registered office: ‥ | ||||
| (h) | Telephone: ‥ | ||||
| (i) | Fax: ‥ | ||||
| (j) | E-mail: ‥ | ||||
| B. | PROPERTY DETAILS | |
| 2. | Type of land: □ State land □ Freehold land | |
| 3. | Land description: | |
| (a) | Title/Lease/Sublease No (as applicable): ‥ | |
| (b) | Lot No: ‥ | |
| (c) | Plan No: ‥ | |
| (d) | Island: ‥ | |
| (e) | Province: ‥ | |
| (f) | District/Town (as applicable): ‥ | |
| 4. | Who is/are the registered owner(s) of the land? | |
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| [Please annex Certificate of Title/Lease/Sublease (issued by the Office of the Registrar of Titles within 2 weeks from the date this application is lodged)] | ||
| 5. | Date of purchase: ‥ | |
| 6. | Purchase price: ‥ | |
| [Please annex certified copy of document of transfer] | ||
| 7. | Value of land: ‥ | |
| [Please annex certified copy of valuation certificate] | ||
| 8. | Has the applicant begun construction? □ Yes □ No | |
| [Note: under the Land Sales Act 1974, construction means “the construction of a new residential dwelling which incurs building costs not less than $250,000”] | ||
| [If you have ticked yes in paragraph 8, please fill out paragraph 8A. If you have ticked no, please skip to paragraph 8B.] | ||
| 8A. | If construction has commenced: | |
| (a) | When did construction commence? | |
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| [Please annex evidentiary documentation] | ||
| (b) | What is the status of construction? | |
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| [Please annex evidentiary documentation] | ||
| (c) | What are the total expenses incurred by the construction so far? | |
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| [Please annex evidentiary documentation] | ||
| (d) | Why is the applicant unable to complete construction within the prescribed period? | |
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| [Please annex evidentiary documentation] | ||
| (e) | Has the applicant engaged the services of a building contractor? | |
| □ Yes □ No | ||
| [Please annex copy of contract, or equivalent] | ||
| (f) | How much more time does the applicant require to complete construction? | |
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| [Please annex evidentiary documentation from your building contractor confirming the intended date of completion] | ||
| 8B. | If construction has not commenced: | |
| If you have ticked no in paragraph 8— | ||
| (a) | Please provide reasons. | |
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| [Please annex evidentiary documentation, if applicable] | ||
| (b) | How much more time does the applicant require to complete construction? | |
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| [Please annex evidentiary documentation] | ||
| C. | MISCELLANEOUS | |
| 9. | Has the applicant ever been declared bankrupt? | |
| □ Yes □ No | ||
| 9A. | If you have ticked yes in paragraph 9, please provide details. | |
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| 10. | If a company, has the company ever been insolvent or the subject of a winding up order? □ Yes □ No | |
| 10A. | If you have ticked yes in paragraph 10, please provide details. | |
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| 11. | Please provide any other information relevant to this application. | |
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| D. | CORRESPONDENCE | |||
| Please fill in the address for service of documents in the first text box, if the applicant is an individual or in the second text box, if the applicant is a company. | ||||
| [Note: It is a requirement under regulation 5(2) and (3) of the Land Sales Regulations 2016 to provide an address for the service of documents. Service is deemed to be effected if made to the address listed below.] | ||||
| These are the details for: | ||||
| □ Applicant (individual) □ Contact person | ||||
| Name: ‥ | ||||
| [Title] [first name] [middle name] [surname] | ||||
| Physical address: ‥ | ||||
| Telephone: ‥ | ||||
| Fax: ‥ | ||||
| E-mail: ‥ | ||||
| These are the details for: | ||||
| □ Applicant (individual) □ Contact person | ||||
| Name: ‥ | ||||
| Registered office/physical address (as applicable) | ||||
| ‥ | ||||
| Telephone: ‥ | ||||
| Fax: ‥ | ||||
| E-mail: ‥ | ||||
| E. | CHECKLIST | |||
| Please ensure that the following documents are annexed to this application, as applicable: | ||||
| Document | Annexure Number | Annexed? (please tick) | ||
| Certified copy of passport bio-data | ||||
| Corporate diagram | ||||
| Certified copy of financial statements for 3 preceding years | ||||
| Certificate of Title/Lease/Sublease | ||||
| Certified copy of document of transfer | ||||
| Certified copy of valuation certificate | ||||
| Certified copy of contract of building contractor | ||||
| Confirmation of intended date of completion by building contractor | ||||
| F. | DECLARATION AND CONSENT | |
| I declare that— | ||
| (a) | the information provided in this application form and in any annexure is true and correct at the time of signing; | |
| (b) | all relevant information has been provided with this application; and | |
| (c) | the information provided in this application is not misleading, | |
| and I consent to any inspection of the land described in Part B of this application form by a compliance inspector or valuer in accordance with the Land Sales Regulations 2016. | ||
| □ | If an individual: | |
| Applicant’s signature:.................................................................................................................................................................. | ||
| Date signed:................................................ /................................................. /................................................. | ||
| □ | If a company: | |
| Company name: ‥ | ||
| Company number (if applicable): ‥ | ||
| Country of incorporation: ‥ | ||
| Director’s name: ‥ | ||
| Signature:.................................................................................................................................................................. | ||
| Date signed:................................................ /................................................. /................................................. | ||
| All applications must be submitted to: The Permanent Secretary for Economy Ministry of Economy Level 10, Ro Lalabalavu House Suva Fiji | ||