Form for the Application for Lease on State Land (Urban) Order 2014 (No. 158 of 2014)

REPUBLIC OF VANUATU LAND REFORM ACT [CAP 123) Form for the Application for Lease on State Land (Urban) Order NoJS$of2014 In exercise of the powers conferred on me by subsection 20(1) of the Land Reform Act [CAP 123], I, the Honourable RALPH REGENV ANU, Minister of Lands and Natural Resources, make the fo llowing Order. 1 Form for tbe Application for Lease on State Land (Urban) Form for the Application for Lease State Land (Urban) is set out in the Schedule. 2 Commencement This Order commences on the day on which it is made. Made at Port Vila this 7:?;!;;;~~"::' -,S""'-I'p,,-t-,- ,, 2014. Minister of Lands Form/or the Application/or Lease on State Land (Urban) Order NoJ$Sof2014 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORMS SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) URBAN APPLICATION FORM DOL FORM 8 DEPARTMENT OF LANDS, LANDS SURVEY AND LAND RECORDS Private Mail Bag 9090, Port Vila, Vanuatu Telephone: (678) 228921 5334540 r----------------------------------------------------- ---------~ I I : APPLICATION FOR LEASE ON STATE LAND (URBAN) : : (You must be over 18 years of aKe to applyfor a new lease) : ---------~ •• TWO (2) COPIES OF THIS FORM MUST BE SUBMITTED •• FOR OFFICE l;SE ONLY Application Number: I Fees Paid (Cirde): Yes I No Received by: Amount Paid: Date Received: Receipt No.: LMPC DB ID: I TO BE FILLED OUT BY THE APPLICANT(S) [PLEASE ATTACH ADDITIONAL INFORMATION AS REQUIRED) (,NOTE: APPLICANTS FOR A LEASE ON STATE LAND FOR PUBLIC PURPOSES, CHARITABLE PURPOSES OR FOR PUBLIC INFRASTRUCTURE ARE NOT REQUIRED TO PA Y FEES FOR THIS APPLICATION BUT MUST PROVIDE DETAILS OF THEIR CHARITABLE STATUS (see after Section 1e). FOR ALL OTHER APPLICANTS, FEES FOR THIS APPLICATION ARE NOT REFUNDABLE') la. Applicant Details (If a Person) First Name(s): Surname (s): Occupation: I Address: Phone No.s: I E-mail: I Fax: page 1 of 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORM 8 Nationality: I Citizenship Status: (circle one) CliP Citizen: Yes / No CliP Permit No: (circle one) (Attach copy of Permit) Citizen / Non-Citizen Date issued: Expatriate Resident: Yes / No I Residence Permit No: (circle one) I Date Issued: VIPA Certificate No: Date issued: No of Years: (Attach copy of Certificate) Overseas Resident: Yes / No Country of Residence: (circle one) I No of Years: Other Leases held by the Applicant (List Title Numbers and attach copies of Advice ofReBistration of Lease): lh. Ollwl' i\ppli('ant Dptails (inciuct .. all actditional ct .. t.lils of ,Ill\' otlwl' 1H'l'sons applying fol' the cel'tificate) First Name(s): Surname (s): Occupation: I Address: Phone No.s: E·mail: Fax: Nationality: I Citizenship Status: Citizen / Non-Citizen (circle one) CliP Citizen: Yes / No CliP Permit No: Date issued: (circle one) (Attach copy of Permit) Expatriate Resident: Yes / No Residence Permit No: Date Issued: No of Years: (circle one) VIPA Certificate No: Date issued: No of Years: (Attach copy of Certificate) Overseas Resident: Yes / No Country of Residence: (circle one) Other Leases held by the Applicant (List Title Numbers and attach copies of Advice of ReBistration of Lease): lc. Applicant Detail (If a Company, Charitable Association or Organisation) Legall Registered Name (In fuB): Trading Name (If used): Postal Address: Phone No.: I Email Address: I Fax: Page 20t 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORMS Country of Registration: (Attach Registration Certificate & Articles of Association) VIPA Certificate No: I Business License No: (Attach copy a/Certificate) (Attach copy a/Business License) Are you a registered charity under the Charitable Associations Incorporation Act [CAP 140]?: If Yes, please attach Registration Certificate & Articles of Association Name and Address of Person Holding Responsibility as: a) if a Company: Director of Company and Major Shareholder b) if a Charitable Association: Director and Chairman of the Committee Yes / No (circle one) ["*NOTE: if applying as a Charitable Association, you must provide additional eVIdence that: (a) the Charitable Association operates in the interest of the public as evidenced by the delivery of charitable servIces to a substantial number of people In Vanuatu; and (b) the Charitable Association is a non profitable association; and (c) the activities of the Charitable Association are based solely in Vanuatu}. 2. Land Detail (Attach Location Plan of Area Applied tor) Location Town: Location Area (Suburb or Ward): Title No.s (If applicable): I Pre lndp Title or Old Title (if no Title No.): Area (m'/ha): ["*You must attach the Survey / Title Plan to this Form - or if no such Plan exists, a detailed sketch or aerial map showing the location of the land being applied for]. Give a brief description of the terrain/topography afthe land What is the land currently being used for? Page 3 of 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORM 8 Description of any physical improvement(s) on the land: What is the current zoning of the area where the land is located? 3. Proposed Development of Land The Purpose for which the land will be used: (tick one) o Residential o Commercial (including Tourism) o Industrial o Public infrastructure o Other public purpose (Please State) o Charitable purpose (Please State) .................................... . o Special (Please State) .................................... .. o Other (Please State) .................................... .. Please state the nature of proposed development on the land: What are the proposed improvements to be undertaken on the land? Describe how the development will satisfy planning requirements including: road access; waste water runoff and drainage; provision of water and electricity services; provision for sewerage; and waste disposal. What (if any) public consultations have been undertaken about the proposed development? Page 4 of 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FO RM8 In what way is the proposed development in the public interest? Are there any other development permission(s) that have been applied for? What is the proposed value of the development (please include a estimation of the expenditure associated with any capital investment in the proposed development)? How will the proposed development be funded (include details of the sources offunding)? Please list any other developments that the applicant(s) have been involved in in Vanuatu, Please provide evidence (including bank letters etc) that demonstrate the applicant(s) good commercial reputation. 4. Cultural or Historical Sites or Building Are there any sites or buildings of cultural and/ Of historical significance on the land? Page 5 of 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORM 8 If so, what plans have been put in place to ensure that they are protected? 5. Environmental and Geo Hazard Issues Are there any conservation areas or areas of sensitive ecosystem, endemic species or species with high bio~diversity value on the land or near the land? Is the land vulnerable to the effect of climate change such as rising sea level, flooding rivers, lands slide etc.? Is the land vulnerable to t~e effects of natural disasters such as volcanoes,landslides etc.? Page 6 of 10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORMS APPLICANT(S) STATEMENT I/We applicant(s) declare that the above information is true and correct to the best of my/our knowledge and that all relevant information has been provided to allow the Land Management Planning Committee to make a proper informed decision. I/We applicant(s) declare that we consent to follow all proper processes in the application for a lease over state land including all legal processes of relevance in the tendering of public property. Signature(s) Date Witness(s) •• WARNING" If the Committee considers that any of the information provided is false or misleading, the application will be declined. Page 70(10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORM 8 COMMENT OF RELATED GOVERNMENT AGENCIES ENVIRONMENT DEPARTMENT: Comments and Recommendations Is the land and its location vulnerable or subject to environmental issues? Name of Of fleer completing Checklist: ................................................................................................................... . As the relevant officer I confirm that I have fulfilled all duties with respect to the administrative, financIal and legal requirements of the Department of Lands and relevant legislation and am not acting in bad faith. Signature of OfOcer: "''''" .. ", .... " .. , .................. ", .... ,,, .......... , ................... ,,, ... ,, ............. " ............ , (Departmellt Stamp) GEO-HAZARDS DEPARTMENT: Comments and Recommendations Is the land and its location vulnerable to sea·level rise, flooding or other natural disasters? Name of OfficeI' completing Checklist: As the relevant officer I confirm that I have fulfilled all duties with respect to the administrative, financial and legal requirements of the Department of Lands and relevant legislation and am not acting in bad faith. Signature of Officer: ..................... ", ............... ,', ....... , ...... " ........................... , ............. " .... " ....... .. (Department Stamp) Page 8 0(10 SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORM 8 GEOLOGY AND MINES DEPARTMENT: Comments and Recommendations Is there a quarry on the land? Are there any other issues relating to minerals? Name of Officer completing Checklist: As the relevant officer I confirm that I have fulfilled all duties with respect to the administrative, financial and legal requirements of the Department of Lands and relevant legislation and am not acting in bad faith. Signature of Officer: (Departmellt ~tamp) MUNICIPAL PLANNER: Comments and Recommendations Confirmation that the land is unde.' a Physical plan area? Any issue that Is affecting the area where the land is? Any development permit or license required by this application? Name of Officer completing Checklist: As the relevant officer I confirm that I have fulfilled all duties with respect to the administrative, financial and legal requirements of the Department of Lands and relevant legislation and am not a'cling In bad faith. Signature of Ofnccr: (Department Stamp) Page 9 of 10 .. , SCHEDULE APPLICATION FOR LEASE ON STATE LAND (URBAN) FORMS LANDS & SURVEY DHPARTMENT: Comments and Recommendations Does the area of the land title meet the required sIze for the proposed purpose? Is there any issue/error that affects this land title? Name of Officer completing Checklist: As the relevant offlcer I confirm that I have fulfllled all duties wIth respect to the administrative, financial and legal requirements of the Department of L.ands and relevant legislation and am not acting in bad faith. Signature ofOfflcer: (Department Stamp) VANUATU CULTURAL CENTRE: Comments and Recommendations Confirmation of cultural/historical site in the area or land title. Detail of cultural/historical site if any. Name of Officer completing Checklist: As the relevant officer I confirm that I have fulfilled all duties with respect to the administrative, financial and legal requirements of the Department of Lands and relevant legislation and am not acting in bad faith. Signature of Officer: {Departmellt Stamp} Page 100(10