Duties Form Settlement Statement

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1 Duties Form Settlement Statement Property details Land use entitlement 1 Does this transaction involve a transfer of land use entitlements? What is the total interest in the property/parcel being transferred? 100 Name of company or unit trust ABC ABN/ARBN/ACN Number/class of shares/units being transferred % Total interest in the property/parcel being transferred Property 1 What is the property type? Residential - private dwelling Property address 121 Exhibition St, MELBOURNE VIC 3000 Land identifier(s) Volume: Folio: 111 Change of beneficial ownership Is there a change in beneficial ownership? How is the beneficial interest in the dutiable property being transferred? Deed of disclaimer The land is held in the following structure Fixed trust The legal title to this property is held by abc pty ltd Transferor(s) Transferor 1 Interest held Full name Mr john j smith Address 121 Exhibition St, MELBOURNE VIC 3000 Are you a foreign natural person? Nationality/citizenship ANGOLA Are you retaining an interest in the property? What is your interest held before the transfer? 1 of 1 shares 100 % Page 1 of 8

2 Are you acting on behalf of a trust? Name of trust Johns Trust Is the trust a foreign trust? Beneficiary(s) Name Miss Jane J Smith Type Individual - natural person (s) 1 Interest held Company name ACN/ARBN/ABN Address 121 Exhibition St, MELBOURNE VIC 3000 Name of authorised person Jane Smith Position Chief Executive Officer (CEO) Are you a foreign corporation? Country of incorporation ANTIGUA AND BARBUDA What is your interest held after the transfer? 1 of 1 shares 100 % Are you acting on behalf of a trust? Name of trust Janes trust Is the trust a foreign trust? Beneficiary(s) Name Jane and co Type Company Transaction details Are the transferor(s) and transferee(s) related or associated? What is the relationship? Cousins Page 2 of 8

3 Does the transfer involve a contract? What is the contract date? 01 Jun 2017 What is the settlement date? 01 Jun 2017 What is the transfer date? 01 Jun 2017 Is there an option granted in relation to the property? What is the date of option? 31 Jul 2017 Consideration and value What is the monetary consideration (if any) for the transfer of the property (including any goods transferred)? $ Deposit Paid 10 % $ Rebate/discount provided by transferor (if applicable) $ 5000 Was any non-monetary consideration given for the property? What is the non-monetary consideration? Entitled in equity Does the total market value of the property (including any goods transferred) differ from the monetary consideration paid? What is the total market value of the real property and goods transferred at the date the contract or transfer was executed? Date Total market value 01 Jun 2017 $ GST Does the consideration amount stated in the contract include any amount for GST? Does the transferor make a taxable supply under the contract for the purposes of GST? GST calculation GST exclusive price $ Amount of GST payable in relation to the taxable supply $ Total $ Sale of business/goods Page 3 of 8

4 Is there a sale of business? If the consideration includes the sale of business, the value attributable to the goodwill is $ Is there a related sale of goods to one of the transferees or to any other person, that forms substantially one arrangement with the sale of the property declared above? The value of these goods (plant and equipment) and goodwill is: Goods (plant and equipment) Goodwill $ $ The date of the additional contract for the sale of goods (including any contract for the sale of business) is 01 Jun 2017 The purchaser(s) in the additional contract is: Name Jane do ACN/ARBN/ABN Is this purchaser(s) in the additional contract related or associated to the transferee(s)? In relation to the initial contract and the additional contract for the sale of business and/or goods, was one conditional on the other? Water rights Is there a sale of water rights? What is the consideration for the water rights? $ Additional arrangements Property 1 Are there any other transfers of land which form substantially one arrangement with this transaction? What is the total interest being transferred? 100 % Property address 121 Exhibition St, MELBOURNE VIC 3000 Land identifier(s) Book: 123 Memorial: 456 Concession(s)/exemption(s) Are you applying for a concession or exemption in relation to this transaction? Do you intend to occupy the property as your principal place of residence (PPR)? What is the intended date of occupation? 31 Jul 2017 Page 4 of 8

5 Concession 1 Concession 2 Concession 3 Concession 4 Concession 5 Concession 6 Transfer between spouses or domestic partners - love and affection Relationship to the transferor I am married to the transferor or I am the domestic partner of the transferor Is any person, other than yourself, taking or entitled to take an interest in the property under this transfer? Transfer between spouses or domestic partners - breakdown of relationship Relationship to the transferor I was married or was the domestic partner of the transferor. The transfer was made by reason of breakdown to the marriage or domestic relationships Is any person, other than yourself, taking or entitled to take an interest in the property under this transfer? Principal place of residence concession First home buyer duty reduction I have received or am eligible to receive the First Home Owner Grant (FHOG) for this property First home owner concession First Home Owner Concession-New homes Does either applicant have a spouse or domestic partner who is not included in this application? Spouse name Mr john smith Reason not included tetsing environment At the contract date, did you or your spouse/domestic partner have at least one dependent child? Have you or your spouse ever owned property within Australia which was used and occupied as your principal place of residence? Pensioner concession I/we confirm I/we have never received a pensioner exemption/concession in Victoria? I am the holder of a Newstart Does the transferee name on this form differ from the Card Holder name? Name on card Mr John J Smith Are you the primary card holder? Page 5 of 8

6 Concession 7 Concession 8 Concession 9 Concession 10 Concession 11 Concession 12 Concession 13 Concession 14 Concession 15 Concession 16 Concession 17 Concession 18 Concession 19 Concession 20 Concession 21 Concession 22 Concession 23 Primary production land - disaggregation, goods and water entitlements Address Market value Area of dimension 121 Exhibition St, MELBOURNE VIC 3000 $ m Goods Description of all items Value stock $ Water entitlements Type of water entitlement water use licence Water trading zone Family farm exemption Quantity of water (ML) Value of water entitlement Volume Folio abc What is the relationship between the and Transferor? Niece or Nephew Does the transfer arise from arrangements or a scheme devised for the principal purpose of taking advantage of the family farm exemption? Exempt bodies - government bodies and diplomats Exempt bodies - statutory bodies Exempt bodies - charitable Exempt bodies - health centre and services Exemption or concession for superannuation fund Exemption - bankruptcy Deceased estate exemption and concession s improvement deduction Change of trustees Transfer from trust to beneficiaries Disability trust exemption or concession Transfer to and from trustee or nominee Transfer from apparent purchaser to real purchaser Equity release programme Partition and NICO Page 6 of 8

7 Concession 24 Correction of error Concession 25 Exemption for dutiable transaction effected on more than one instrument Concession 26 Change in manner of holding Concession 27 Shariah financing Concession 28 Conversion of land use entitlement Off-the-plan/house and land/refurbishment sales Is the sale subject to an off-the-plan concession? Which method are you using to calculate the off-the-plan concession? Fixed % - single lot freestanding (45%) Fixed percentage method 100% building works costs $ What percentage of construction works were completed after the contract date? 30 % Deemed construction cost after contract $ Dutiable value $ Sub-sale, nomination and options Purchaser 1 Is the transferee(s) the same party as the purchaser(s) named in the contract? Organisation name SRO ACN/ARBN/ABN Relationships 1. SRO with Did obtain the transfer right to have any part of the property transferred to them by nomination, assignment, novation or otherwise? Date Transfer right acquired 30 Jun 2017 Is a relative of the purchaser or associated to the purchaser? Relationship type Shareholder Is a trustee of a fixed trust and the beneficiaries are relative of the purchaser or associated to the purchaser SRO? Beneficiaries Name Type Relationship Mr John j Smith Individual - natural person Child or grandchild Page 7 of 8

8 Options Parallel Arrangement Land Development Additional Consideration Was there an option granted in relation to this property? What is the date of the option? 13 Jun 2017 Did any land development occur after the option date? Was there a parallel arrangement (building contract) or other arrangement associated with this property? In relation to the property, did any land development (including construction of a building of refurbishment) occur between the contract date and the transfer date? Does the consideration stated in the contract include consideration for the land development? Did the 1st purchaser (or an associate) undertake to participate in the land development at any time before transfer right acquired? Provide details of the land development undertaken between the contract date and the transfer date A plan of subdivision was prepare for the land or steps were taken to register a plan of subdivision under the Subdivision Act Subdivision Date 27 Jun 2017 Was there additional consideration paid/payable in relation to this property including any consideration for the parallel arrangement? Specify the total consideration paid or payable by the transferee in order to acquire the transfer right To the Vendor or as directed by the vendor $ To the 1st purchaser(s) $ 1000 To any other parties $ 1000 Under parallel arrangement (if applicable) $ Total consideration $ Did any of the consideration paid above include 'excluded costs' Electronic Submission The Electronic Submission Statements (Victoria) Act 2000 establishes the regulatory framework for transactions to be completed electronically. Privacy This information is collected by the SRO for the general administration of land transfer duty, including the calculation of any duty that may be payable on the transfer of dutiable property. If you do not provide the information required, we may not be able to process this transaction. The information collected may be used for the purposes of other legislation administered by the SRO. Where authorised by law to do so, we may also disclose this information to other government agencies including the ATO for the purpose of the Third Party Reporting requirements, 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 Page 8 of 8

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