This form is to be used to notify the construction occupations registrar of possible contraventions of building and development approvals – building work. Under section 50 of the Building Act 2004 a certifier commits an offence if the certifier does not inform the constructions occupations registrar.

This form is to be submitted
(i) if the building work is fundamentally noncompliant—not later than the next working day after the day the contravention comes to the certifier’s attention; or
(ii) in any other case—within 21 days after the day the contravention comes to the certifier’s attention.
1. Property description - The description must identify all land subject to the building approval.	
Suburb                                                                               Block                                    Section
    					
Plan registration number	            Development approval number

2. Private certifier 	
Name (in full)                                                                      Licence number
			
Company name (if applicable)	       Email address
			
Phone number (business hours)	                                   Mobile number	             Fax number

3. Builder details	
Name (in full)                                                                      Licence number
			
Company name (if applicable)	       Email address
			
Phone number (business hours)	                                   Mobile number	             Fax number

4. Non-compliance	

The contravention is considered to be:  

Indicate the stage/s that do not comply

	

	

Indicate any directions that have been given to the builder in order to rectify the non-compliance (if no direction has been given please state why).

	

	

5. Signature	
Signature of Certifier
	
Date	

6. Contact details	

Privacy Notice 
The personal information on this form is being collected under section 50 Building Act 2004. Information that you provide may be disclosed to the Australian Bureau of Statistics, ACT Revenue Office and the Taxation Office. The information may also be accessed by other government agencies and commercial organisations interested in building information.

you are asked to provide will be used to ………………. The lawful authority for the collection of this information is the 

CONTACT INFORMATION
  Email:
  ACTPLAedevlopmentBA@act.gov.au
	Post:
Access Canberra
Building Services 
Shopfront Mitchell
GPO Box 158
Canberra, ACT 2601	In Person:
Please visit www.act.gov.au/accessCBR
Or call 132281 to find an 
Access Canberra Shopfront.