Centrelink - Real Estate Details (Mod R) Instructions
This form contains 186 fields organized into 50 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Security Property Details | ||
| No | Checkbox |
Check this box if no other property has been used to secure this mortgage. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if another property (including your home property) has been used to secure this mortgage. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| Additional Security Property Reference | Text |
Enter any additional reference or specific details about the property used as security, if applicable. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Security Property Address Line 1 | Text |
Enter the first line of the address for the additional property used to secure the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Security Property Address Line 2 | Text |
Enter the second line of the address for the additional property used to secure the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Security Property Address Line 3 | Text |
Enter the third line of the address for the additional property used to secure the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Security Property Address Line 4 | Text |
Enter the fourth line of the address for the additional property used to secure the loan, typically the suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Security Property Postcode | Text |
Enter the postcode for the additional property used to secure the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Estimated Market Value | Number |
Enter the estimated market value of the additional property used to secure the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Building Description | ||
| Approximate Floor Area | Number |
Enter the approximate total floor area of the building in square meters.
|
| Building Age | Text |
Provide the age of the building in years.
|
| Exterior Construction Type | Text |
Describe the exterior construction materials of the building, for example, brick or timber.
|
| Interior Construction Type | Text |
Describe the interior construction materials of the building, for example, plaster or not lined.
|
| Roof Construction Type | Text |
Describe the roof construction materials of the building, for example, metal or tiles.
|
| General Condition | Text |
Indicate the general condition of the building, such as fair, good, or poor.
|
| Total Flats/Units in Complex | Text |
Enter the total number of flats or units within the complex, if applicable.
|
| Number of Bedrooms | Text |
Provide the number of bedrooms in the residential building.
|
| Number of Other Rooms | Text |
Provide the number of other rooms in the building, excluding laundry, bathroom, and toilet.
|
| Business Use of Home Property | ||
| No | Checkbox |
Check this box if you are NOT using any rooms or buildings of your home property exclusively for business purposes. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| DummyCalcQ12 | Text | |
| Yes | Checkbox |
Check this box if you ARE using rooms or buildings of your home property exclusively for business purposes. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Business Use of Surrounding Land | ||
| No | Checkbox |
Check this box if no portion of the land surrounding your home property is used primarily for business purposes. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Other Business Land Use Reasons | Text |
Please specify any other reasons why the land surrounding your home property is used primarily for business purposes. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Yes | Checkbox |
Check this box if any portion of the land surrounding your home property is used primarily for business purposes. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Checklist of Provided Documents | ||
| Real estate details (Mod R) form | Checkbox |
Check this box if you are providing the 'Real estate details (Mod R)' form for each property you own, as required for question 5.
|
| Copy of latest council rate/valuation notice | Checkbox |
Check this box if you are providing a copy of the latest council rate/valuation notice, as required for question 8.
|
| Documents for water asset details | Checkbox |
Check this box if you are providing documents to show details of each water asset, as required for question 9.
|
| Copy of each title deed | Checkbox |
Check this box if you are providing a copy of each title deed, as required for question 19.
|
| Documents for 20+ year home property | Checkbox |
Check this box if you are providing documents to evidence the property has been your home for 20 years or more continuously, applicable if you answered Yes at question 21. Fill only if 'Has the property been your home property for 20 years or more continuously?' is 'Yes'.
Depends on:
Yes
|
| Mortgage/loan agreements and statements | Checkbox |
Check this box if you are providing your mortgage or loan agreement(s) showing which assets or properties are held as security against the loan and the latest statement of each loan account, applicable if you answered Yes at question 33. Fill only if 'Is the property mortgaged or encumbered?' is 'Yes'.
Depends on:
Yes
|
| Rental property tax return and statements | Checkbox |
Check this box if you are providing a copy of your last Income Tax Return, rental profit/loss statement, and Depreciation Schedule for the rental property, applicable if you answered Yes at question 36. Fill only if 'Do you (and/or your partner) receive any rental income from the lease of the property?' is 'Yes'.
Depends on:
Yes
|
| Personal and business tax return and financial statements | Checkbox |
Check this box if you are providing a copy of your last personal and business Income Tax Return and financial statements, applicable if you answered Yes at question 38. Fill only if 'Do you (and/or your partner) receive any non-rental income from the property?' is 'Yes'.
Depends on:
Yes, non-rental income
|
| Circumstances Affecting Property Value | ||
| No circumstances affecting value | Checkbox |
Check this box if there are no circumstances affecting the value of the property.
|
| Yes, circumstances affect value | Checkbox |
Check this box if there are circumstances affecting the value of the property and you need to provide details.
|
| Brief Circumstance Details | Text |
Enter brief details about the circumstances affecting the property's value.
|
| Detailed Circumstance Description | Text |
Provide a detailed description of any circumstances affecting the value of the property, such as lack of adequate fencing, rocky ground, or unusual title. Fill only if 'Yes, circumstances affect value' is 'Yes'.
Depends on:
Yes, circumstances affect value
|
| Current Market Value of Property | ||
| Estimated Current Market Value | Number |
Please provide the estimated current market value of the property, including land, buildings, and water assets. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Current Property Use | ||
| Do not currently make any use of the property | Checkbox |
Check this box if you or your partner do not currently make any use of the property. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Primary production | Checkbox |
Check this box if the property is currently used for primary production. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Rural residential only | Checkbox |
Check this box if the property is currently used for rural residential purposes only. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Leased | Checkbox |
Check this box if the property is currently leased. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Other commercial or business use | Checkbox |
Check this box if the property is currently used for other commercial or business purposes (e.g., commercial kennels). Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Hobby farm | Checkbox |
Check this box if the property is currently used as a hobby farm. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Other | Checkbox |
Check this box if the property is currently used for a purpose not listed above, and provide details below. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Other Property Use (Details) | Text |
Provide specific details if you use the property for any purpose other than those listed in the 'Other commercial or business use' section. Fill only if 'Other' is selected.
Depends on:
Other
|
| Property Use General Description | Text |
Provide a comprehensive description of how you or your partner currently use the property, especially if selecting an 'Other' category. Fill only if 'Other' is selected.
Depends on:
Other
|
| Customer Reference Number | ||
| Customer Reference Number Part 1 | Text |
Enter the first part of your customer reference number.
|
| Customer Reference Number Part 2 | Text |
Enter the second part of your customer reference number.
|
| Customer Reference Number Part 3 | Text |
Enter the third part of your customer reference number.
|
| Customer Reference Number Part 4 | Text |
Enter the fourth part of your customer reference number.
|
| Date of Birth | ||
| Date of Birth | Date |
Please enter your date of birth.
|
| Date of Ownership Settlement | ||
| Date of Settlement | Date |
Please provide the date when the property came into your or your partner's ownership.
|
| Family Use of Property for Support | ||
| No | Checkbox |
Check this box if no person in your family uses the property to support themselves. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if a person in your family uses the property to support themselves and you will provide a description. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Family Member's Name or Relation | Text |
Enter the name or relationship of the family member who uses the property to support themselves. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Description of Property Use for Support | Text |
Provide a detailed explanation of how the family member uses the property to support themselves. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Full Name | ||
| Family Name | Text |
Please provide your family name as it appears on your official identification documents.
|
| First Given Name | Text |
Please provide your first given name as it appears on your official identification documents.
|
| Second Given Name | Text |
Please provide your second given name as it appears on your official identification documents.
|
| General | ||
| Instructions | Button | |
| Q6.PropertyAddress1 | Text | |
| Q6.PropertyAddress2 | Text | |
| Q6.PropertyAddress3 | Text | |
| Q11GoToQ28 | Button | |
| Q12GoToQ14 | Button | |
| Q14GoToQ16 | Button | |
| Q16GoToQ18 | Button | |
| Q18GoToQ20 | Button | |
| Q20GoToQ28 | Button | |
| Q21GoToQ28 | Button | |
| Q25GoToQ28 | Button | |
| Q33GoToQ36 | Button | |
| Q36GoToQ38 | Button | |
| Q40GoToQ43 | Button | |
| Button | ||
| Clear | Button | |
| Home and Surrounding Title Details | ||
| Estimated Value of Home and Surrounding Title | Number |
Enter the estimated value of the home and surrounding title. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Legal Description and Area of Title | Text |
Provide the legal description and area of the title on which the home sits. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Home Property Ownership Duration | ||
| No | Checkbox |
Check this box if your property has not been your home property for 20 years or more continuously. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Continuous Ownership Years | Number |
Please enter the number of years the property has been continuously owned. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if your property has been your home property for 20 years or more continuously. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Household Contents Valuation | ||
| Current Market Value | Number |
Enter your estimate of the current market value of the household contents you own in the property. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Amount Owed | Number |
Enter the estimated amount owed on the household contents. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Your Share Percentage | Number |
Enter your percentage share of the household contents. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Partner's Share Percentage | Number |
Enter your partner's percentage share of the household contents. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Legal Property Description | ||
| Legal Property Description | Text |
Enter the full legal description of the property, which may include lot, section, or parish details. If the property consists of multiple titles, provide details for each separate title. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Loan Details | ||
| Loan Amount Owed | Number |
Enter the total amount you and/or your partner owe for the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Annual Interest Rate | Number |
Enter the annual interest rate for the loan. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Loan Purpose | Text |
Provide a detailed explanation of the purpose for which the loan was obtained. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Non-rental Income Details | ||
| No non-rental income | Checkbox |
Check this box if you and your partner do not receive any non-rental income from the property.
|
| Yes, non-rental income | Checkbox |
Check this box if you or your partner receive any non-rental income from the property and need to provide details below.
|
| Income Details Indication | Text |
Please provide a brief indicator or confirmation if you are providing details for non-rental income. Fill only if 'Yes, non-rental income' is 'Yes'.
Depends on:
Yes, non-rental income
|
| Source of Non-Rental Income | Text |
Please specify the source of the non-rental income received from the property, for example, hobby farming or agistment. Fill only if 'Yes, non-rental income' is 'Yes'.
Depends on:
Yes, non-rental income
|
| Gross Amount Received Per Week | Number |
Please enter the gross amount of non-rental income received before tax on a weekly basis. Fill only if 'Yes, non-rental income' is 'Yes'.
Depends on:
Yes, non-rental income
|
| Number of Properties | ||
| Number of Properties Owned | Text |
Enter the total count of properties you and/or your partner own or have an interest in, both in Australia and overseas.
|
| Other Ownership Details | ||
| Other | Checkbox |
Check this box if the property is owned by an entity or person other than yourself or your partner, and you need to provide their details. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Name of Other Entity | Text |
Please provide the name of the other person or entity that owns the property. Fill only if 'Other' is selected.
Depends on:
Other
|
| Percentage Owned by Other Entity | Number |
Please enter the percentage of the property owned by the other person or entity. Fill only if 'Other' is selected.
Depends on:
Other
|
| Other Property Type Details | ||
| Other Property Type | Text |
Enter the specific type of property if it does not fit into the predefined categories. Fill only if 'Q7_Other' is 'Yes'.
Depends on:
Q7_Other
|
| Additional Property Type Details | Text |
Provide any further relevant details about the 'Other' property type. Fill only if 'Q7_Other' is 'Yes'.
Depends on:
Q7_Other
|
| Partner's Ownership Details | ||
| Your partner | Checkbox |
Check this box if your partner owns a percentage of the property. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Partner's Percentage Owned | Number |
Enter the percentage of the property owned by your partner. Fill only if 'Your partner' is selected.
Depends on:
Your partner
|
| Partner's Signature Date | ||
| Partner's Signature Date Day | Text |
Enter the day your partner signed the form.
|
| Pension Claim Status | ||
| No | Checkbox |
Check this box if you and/or your partner are NOT over Age Pension age OR are NOT receiving or claiming any of the listed pensions/payments. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| DummyCalcQ20 | Text | |
| Yes | Checkbox |
Check this box if you and/or your partner ARE over Age Pension age AND ARE receiving or claiming any of the listed pensions/payments. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Potential Commercial Use of Property | ||
| No | Checkbox |
Check this box if there is no potential commercial use of the property. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if there is potential commercial use of the property. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Potential Commercial Use Summary | Text |
Please provide a brief description of the potential commercial use of the property. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Commercial Use Details | Text |
Please provide a detailed explanation of the potential commercial use of the property, including any relevant activities or plans. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Property Address | ||
| Street Address | Text |
Enter the street number and street name of the property.
|
| Suburb/City/State | Text |
Enter the suburb, city, or state where the property is located.
|
| Postcode | Text |
Enter the postcode of the property's address.
|
| Country | Text |
Enter the country where the property is located, if it is not Australia.
|
| Property Area and Dimensions | ||
| Area in Hectares | Number |
Enter the area of the property in hectares.
|
| Area in Acres | Number |
Enter the area of the property in acres.
|
| Area in Square Metres | Number |
Enter the area of the property in square metres.
|
| Dimension 1 | Number |
Enter the first dimension of the property.
|
| Dimension 2 | Number |
Enter the second dimension of the property.
|
| Property Encumbrance Status | ||
| No | Checkbox |
Check this box if the property is not mortgaged or encumbered. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| DummyCalcQ33 | Text | |
| Yes | Checkbox |
Check this box if the property is mortgaged or encumbered. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| Property Inspection Authorization | ||
| No | Checkbox |
The user should check this box if they do not authorize a licensed valuer to enter and inspect the property for valuation purposes.
|
| Noted Person | Text |
Please provide the name of the person Centrelink or its representative should contact to arrange a mutually convenient time for any inspection of the property.
|
| Yes | Checkbox |
The user should check this box if they authorize a licensed valuer to enter and inspect the property for valuation purposes.
|
| Property Location Directions | ||
| Property Directions | Text |
Provide detailed directions to the property or information for a map if the location is difficult to find.
|
| Property Ownership Acquisition | ||
| Purchased | Checkbox |
Check this box if the property was acquired by purchasing it.
|
| Purchase Price Qualifier | Number |
Provide any numerical qualifier related to the property's purchase price. Fill only if 'Purchased' is 'Yes'.
Depends on:
Purchased
|
| Purchase Price | Number |
Provide the monetary amount of the property's purchase price. Fill only if 'Purchased' is 'Yes'.
Depends on:
Purchased
|
| Inherited/Gifted | Checkbox |
Check this box if the property was acquired through inheritance or as a gift.
|
| Other | Checkbox |
Check this box if the property was acquired by a method other than purchasing, inheriting, or being gifted.
|
| Other Acquisition Details | Text |
Provide detailed information explaining how the property came into ownership, if not by purchase, inheritance, or gift. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Property Ownership Details | ||
| Your Percentage Owned | Number |
Enter the percentage of the property that you own. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Property Ownership Inquiry | ||
| No | Checkbox |
Check this box if the property is not fully owned by a private company and/or private trust that you are involved in.
|
| Yes | Checkbox |
Check this box if the property is fully owned by a private company and/or private trust that you are involved in, and you are required to complete a separate Private Company (Mod PC) form and/or Private Trust (Mod PT) form.
|
| Property Rental Duration | ||
| Weeks Property Rented Annually | Text |
Enter the number of weeks per year the property is rented. Fill only if 'Do you (and/or your partner) receive any rental income from the lease of the property?' is 'Yes'.
Depends on:
Yes
|
| Property Residency Status | ||
| No | Checkbox |
Check this box if neither you nor your partner live on the property. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| DummyCalcQ11 | Text | |
| Yes | Checkbox |
Check this box if you and/or your partner live on the property. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Property Size Confirmation | ||
| No | Checkbox |
Check this box if the property is not larger than 2 hectares (5 acres). Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| DummyCalcQ16 | Text | |
| Yes | Checkbox |
Check this box if the property is larger than 2 hectares (5 acres). Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Property Type | ||
| Q7_Vacant | CheckBox | |
| Q7_Bush | CheckBox | |
| Q7_Bus | CheckBox | |
| Q7_House | CheckBox | |
| Q7_Flat | CheckBox | |
| Q7_Units | CheckBox | |
| Q7_Retail | CheckBox | |
| Q7_Comm | CheckBox | |
| Q7_Industrial | CheckBox | |
| Q7_Farm | CheckBox | |
| Q7_Market | CheckBox | |
| Q7_2ha | CheckBox | |
| Q7_Other | CheckBox | |
| Reasons for Not Using Property for Income | ||
| Rural residential block | Checkbox |
Check this box if your property is a rural residential block, preventing it from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Land not viable for commercial or agricultural use | Checkbox |
Check this box if the land is not viable for commercial or agricultural use, preventing it from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Caring responsibilities | Checkbox |
Check this box if caring responsibilities prevent your property from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Health reasons | Checkbox |
Check this box if health reasons prevent your property from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Zoning restrictions | Checkbox |
Check this box if zoning restrictions prevent your property from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Environmental restrictions | Checkbox |
Check this box if environmental restrictions prevent your property from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other | Checkbox |
Check this box if there is another reason not listed that prevents your property from being used to produce income. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Reason Details | Text |
Please provide specific details for the 'Other' reason why your property is not being used to produce an income. Fill only if 'Other' is selected.
Depends on:
Other
|
| Detailed Explanation for Not Using Property | Text |
Provide a detailed explanation for why your property is not being used to produce an income. Fill only if 'Other' is selected.
Depends on:
Other
|
| Reasons Preventing Income Production From Property | ||
| No | Checkbox |
Check this box if there are no reasons preventing you or your partner from using the property to produce an income. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Income-Producing Property Identifier | Text |
Please provide a brief description or identifier for the property or asset that is being referred to as potentially producing income. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if there are reasons preventing you or your partner from using the property to produce an income. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Rental Income Details | ||
| No | Checkbox |
Check this box if you and/or your partner do not receive any rental income from the lease of the property. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| DummyCalcQ36 | Text | |
| Yes | Checkbox |
Check this box if you and/or your partner receive rental income from the lease of the property. Fill only if 'Are you (and/or your partner) over Age Pension age' is 'Yes'
Depends on:
Yes
|
| Gross Rent Amount Per Week | Number |
Provide the gross amount of rent received per week, before tax and other deductions. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Title Amalgamation Status | ||
| No | Checkbox |
Check this box if two or more titles have not been amalgamated since 9 May 2006. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if two or more titles have been amalgamated since 9 May 2006. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Title Document Information | ||
| No | Checkbox |
Check this box if the property does not have more than 1 title document. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| DummyCalcQ18 | Text | |
| Yes | Checkbox |
Check this box if the property has more than 1 title document. Fill only if 'Is the property fully owned by a private company and/or private trust that you are involved in?' is 'No'.
Depends on:
No
|
| Value of Home and Surrounding Land | ||
| Estimated Value of Home and Surrounding Land | Number |
Provide the estimated value of the home and the surrounding 2 hectares (5 acres). Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Value of Land Used for Business | ||
| Business Land Portion Value | Number |
Provide the monetary value of the portion of land (up to 2 hectares or 5 acres) surrounding your home property that is used primarily for business purposes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Value of Property Used for Business | ||
| Value of Rooms or Buildings Used for Business | Number |
Enter the monetary value of the rooms or buildings of your home property that are used exclusively for business purposes. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Valuer Contact Information | ||
| Contact Person Name | Text |
Enter the full name of the person who should be contacted by the valuer. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Contact Person Phone Number | Text |
Enter the daytime phone number for the contact person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Your Ownership Details | ||
| You | Checkbox |
Check this box if you are an owner of the property. Fill only if 'Unnamed Question on Page 3' is 'Yes'.
Depends on:
Yes
|
| Your Percentage Owned | Number |
Please enter the percentage of the property that you own. Fill only if 'You' is selected.
Depends on:
You
|
| Your Signature Details | ||
| Sign | Text | |
| Signature Date | Date |
Please enter the date you are signing this form. Fill only if 'Your Signature' is filled.
Depends on:
Your Signature
|
| Your Signature | Text |
Please provide your signature.
|