Changes to building and construction or personal details

Step 1 of 4 - Your Details

Title *

-- Please Select --MrMrsMsMissDr

First Name *

Last Name *

Company Name

Phone *

Email *

Date *

I certify that the information provided is true and correct to the best of my knowledge *

• Yes
• No

Step 2 of 4 - Building & Construction Work

Customer Name *

Levy Number *

Description of work *

Building and construction work address *

Suburb *

State

-- Please Select --ACTNSWNTQLDSATASVICWA

Postcode *

Step 3 of 4 - Information to be changed

Which details would you like to change

Please select all that apply.

• Lot/plan number
• Building and construction work description
• Owner
• Address
• Private certifier/council
• Start date
• Completion date (There is no need to complete this form if the end date falls within the same month as previously notified)
• Principal contractor
• Cost of Work
• Personal Details

Lot/Plan number

To

From

Building and construction work description

To

From

Owner

To

From

Contact number

Contact email address

Address To

Address

Suburb

State

ACTNSWNTQLDSATASVICWA

Postcode

Address From

Address

Suburb

State

ACTNSWNTQLDSATASVICWA

Postcode

Private Certifier / Council

To

From

Contact number

Contact email address

Start date

Start date previously notified

New start date

Completion date

Completion date previously notified

New completion date

Principal contractor

To

From

Contact number

Contact email address

Cost of work

Notified cost of work (excluding GST) Enter whole numbers only

Exempted cost of work (excluding GST) Enter whole numbers only

By how much has the cost of work increased or decreased? (excluding GST)

Increased by $20,000 or moreIncreased by LESS than $20,000Decreased by $20,000 or moreDecreased by LESS than $20,000Not Applicable

New cost of work (excluding GST) Enter whole numbers only

New exempted cost of work (excluding GST) Enter whole numbers only

Is an alternative person/company/address required to receive the invoice?

An invoice for additional levy will be issued to person / company / address listed as the Payer on the Notification and Payment Form. If an alternative person / company / address is requried to receive the invoice, please provide the details below.

• Yes
• No

New cost of work (GST exclusive) Enter whole numbers only

After submitting this form, please complete a Levy Refund application form. Supporting documentation is required

• OK

New cost of work (excluding GST) Enter whole numbers only

Exempted cost of work (excluding GST) - No adjustment to the levy is required as the cost of work has decreased by less than $20,000. Enter whole numbers only

Supporting documents

Supporting documents

Supporting documents Supporting documents for final costs and exempted costs must be attached.

Supporting documents Supporting documents for final costs and exempted costs must be attached.

Personal details

Title

-- Please Select --MrMrsMsMissDr

First Name

Last Name

Contact number

Email address

Step 4 of 4 - Declaration

I certify that the information provided is true and correct to the best of my knowledge. *

• Yes
• No

Name *

Company name

Contact phone *

Email address *

Date