Customer Code:

Agent (if applicable)

Number of dealings to be lodged:

Lodging summary form

Total Fees:

Date

Lodged by

Lodging sequence Type Fee NOA Form Your reference

Vol/Folio

Certificate of Title (CofT)

Land Use Victoria contact details: www.delwp.vic.gov.au/property>Contact usTHE BACK OF THIS FORM MUST NOT BE USED

Email

CofT location

Dealing number allocated

Phone(correspondence will be sent to this email for the attached lodgment)

Customer Code Direct Debit Enabled

For more information on using direct debit as a form of payment please refer to the Fees and direct debit page at www.propertyandlandtitles.vic.gov.au.

Name: