Retirement Village COI Retirement Village COI Step 1 of 12 8% Welcome to the bytherules Retirement Home engagement form. By completing this form, you will ensure the purchase of your Retirement Home runs as smoothly as possible. Please answer all of the questions. At the end of this form, you will be asked to pay a $200.00 Outlays Deposit which will be used to pay for costs we may incur on your behalf, such as searches. Any balance will be returned at settlement.Village Name(Required) Name of the Retirement VillageProperty Address(Required) Street Address Address Line 2 City State Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country This is the address of the Unit, Villa or Apartment you are purchasingHiddenConveyancer Email HiddenConveyancer PhoneWhy Did You Choose bytherules?please choose…Real Estate Agent RecommendedMortage/Finance Broker RecommendedFriend Referred MeOnline Search / WebsiteSocial Media, eg FacebookUsed You Beforeif you don’t mind us asking, could you say why you chose bytherulesNumber of Residents(Required)OneTwoClient 1Name(Required) First Middle Last Current Address(Required) Street Address Address Line 2 City State Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Phone(Required)Email(Required) Date of Birth(Required) DD slash MM slash YYYY Residency Status(Required)Select…Australian CitizenAustralian Permanent ResidentAustralian Temporary ResidentOtherProvide Further Details(Required) Client 2Name(Required) First Middle Last Current Address(Required) Street Address Address Line 2 City State ostal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Phone(Required)Email(Required) Date of Birth(Required) DD slash MM slash YYYY Residency Status(Required)Select…Australian CitizenAustralian Permanent ResidentAustralian Temporary ResidentOtherProvide Further Details(Required) How do you intend to share ownership of the Property?(Required)Select…Joint TenantsTenants in Common in equal sharesTenants in Common in unequal sharesClient 1 share:(Required) Client 2 share:(Required) Authorised ContactDo you wish to authorise us to take instructions from another person?(Required)Select…YesNoE.g. an Attorney or Next of KinName(Required) First Middle Last Current Address(Required) Street Address Address Line 2 City State Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Phone(Required)Email(Required) Sales Agent / Village Manager Contact DetailsHave you been dealing with a Sales Agent or Village Manager?(Required)YesNoPlease provide their contact details below.Agent Name(Required) First Last Agent Phone(Required)Agent Email(Required) Has the Sales Agent made any warranties or promises to you regarding the Property or Village?(Required)Select…YesNoN/APlease advise the details:(Required) Funding your PurchaseHow much is the Ingoing Contribution (Purchase Price)?(Required)Have you paid a Deposit?(Required)Select…YesNoAmount of Deposit Paid(Required)Proposed Settlement Date of your Retirement Home Purchase DD slash MM slash YYYY Let us know what date you plan to move in. Leave blank if unsure.Do you need to sell your existing Home in order to fund your entry into the Village?(Required)Select…YesNo Sale of your Existing HomeAddress of your Existing Home(Required) Street Address Address Line 2 City State Postal Code Have you entered into a Sale Contract?(Required)Select…YesNoName of your Conveyancer(Required) Do you authorise us to liaise directly with the Conveyancer to arrange settlement?(Required)Select…YesNoSettlement Date of your Sale DD slash MM slash YYYY Leave blank if unsure.Will the Sale Price be sufficient to cover Ingoing Contribution (Purchase Price)?(Required)Select…YesNoWill Settlement of your Sale be contemporaneous with your Retirement Home Purchase?(Required)Select…YesNoDo you need early access to move into the Village?(Required)Select…YesNoThe Village Manager may be able to negotiate for you to have early access to your Unit prior to settlement in order to make your move less stressful. Please ensure that you contact the Village Manager and request approval for early access as soon as possible. They may require you to enter into an Early Access or Early Occupation Licence/Deed. If so, please forward us a copy for review prior to signing. Other MattersDo you have a pet that will be living with you in the Property?(Required)Select…YesNoHave you requested and obtained consent from the Operator for your Pet to reside in the Village?(Required)Select…YesNoYou must have consent from the Village Manager before you are permitted to have your Pet live in the Village. Please ensure that you contact the Village Manager and request approval as soon as possible.Do you have any particular concerns regarding the Property or Village?(Required)Select…YesNoPlease provide details of your concerns:(Required) Your Bank DetailsWe may need to refund surplus Trust Funds to your account following Settlement. To assist us, please provide your Bank Details below.Name of Bank(Required) Account Name(Required) BSB(Required) Account Number(Required) Optional SearchesTitle Search of Retirement Village Land ($30.00 per lot – please note that the Retirement Village may consist of multiple lots)(Required)Select…YesNoThis will identify any defects or encumbrances on the Title to the Retirement Village Land which could affect your interest. Any defects or encumbrances should have been disclosed by the Operator in Item 2.7 of the Form 4 – Prospective Costs Document (PCD).ASIC Company Search of the Operator ($23.32)(Required)Select…YesNoThis will identify whether the Operator is currently under the control of an administrator or in liquidation.HiddenSearch of the Queensland Government Department of Public Housing and Works Register (Free)Select…YesNoThis will confirm that the Retirement Village is registered. If the Retirement Village is not registered, you may terminate the Residence Contract and obtain a refund of your Ingoing Contribution.QCAT Search ($55.00)(Required)Select…YesNoThis will reveal whether the Operator is currently in a dispute with any of the other residents of the Retirement Village.HiddenHow to order a QCAT searchGo to Konekta >>> Infotrack >>> All Products >>> All Services (at the top of the browser) >>> Courts (left hand side) >>> Litigation Search: 1. Enter full name of Scheme Operator (e.g. “Freedom Aged Care Morayfield (Operations) Pty Ltd”); 2. Select “QLD – Civil Administrative Tribunal”; 3. Enter Additional comments “Please conduct a search of the QCAT Register for information regarding any Retirement Village disputes affecting the party”. HiddenSearches not requested Documents given to you by the Village Operator or Sales AgentPlease upload a copy of any Documents given to you by the Village Operator or Sales Agent Drop files here or Select files Max. file size: 50 MB. Documents may include: 1. Residence Contract (may also be described as a Lease or Licence); 2. Form 3 – Village Comparison Document; 3. Form 4 – Prospective Costs Document; 4. Village By-Laws.When did you receive the Documents? DD slash MM slash YYYY Leave blank if unsure. Terms & ConditionsAuthority to Act For You I/We certify that I/We are the client or client agent and have the legal authority to instruct bytherules conveyancing in relation to the conveyancing transaction and that I/We have no notice of the revocation of my/our authority to act on behalf of the client. I/We Authorise bytherules Conveyancing to act on my/our behalf in the conveyance of the property detailed on this form. I/We INSTRUCT bytherules Conveyancing to act on my/our behalf, or where I/We are the client agent to act on behalf of the client, in accordance with the terms of this client authorisation and any participation rules and any prescribed requirements to: 1. sign documents on my/our behalf as required for the conveyancing transaction(s); and 2. submit or authorise submission of documents for lodgement with the relevant land registry; and 3. authorise any financial settlement involved in the conveyancing transaction(s); and 4. do anything else necessary to complete the conveyancing transaction(s). I/We NOTE Your ADVICE and understand that you are not able to provide advice on the commercial viability or succession, matrimonial or financial consequences, or the tax implications of this sale or purchase. I/We HEREBY AUTHORISE REQUEST AND DIRECT you to pay our professional costs (as quoted) and outlays paid and/or incurred from moneys held in your trust account or charge my/our Credit Card on my behalf. I/WE ACKNOWLEDGE AND AGREE that any action being taken by you to recover any amount due and payable by us, any costs incurred by you in recovering such amount due (including without limitation any legal expenses on a solicitor/client basis, collection agency charges or any other reasonable associated costs) are payable by us to you and shall be recoverable by you as a separate debt. I/We HEREBY APPOINT bytherules Conveyancing to act as my/our agent for the purpose of paying any Government tax, fee or charge that is specified in the determination of the treasurer made pursuant to any lawfully gazetted taxation act. I/We ARE AUTHORISED to make this declaration and state that the information contained herein is correct to the best of my knowledge and such information may be provided to any Government agency lawfully requiring such information. I/We HEREBY AUTHORISE AND DIRECT you to forward to us the original stamped contract at the conclusion of this matter and that you will retain only electronic copies of the documents for a period of 7 years. I/We HEREBY AUTHORISE AND DIRECT you to communicate directly with the Real Estate Agent (if applicable) and take any steps to protect my/our interest in respect of this transaction. I/We HEREBY AUTHORISE AND DIRECT you to obtain an extension on any occasion to protect my/our interest if I/we are not contactable at a time when a due date falls. I/We HEREBY CONSENT to the delivery of invoices and notices by electronic means to the email address supplied in these instructions.Client 1 – Signature(Required)Client 2 – Signature(Required)Date(Required) DD slash MM slash YYYY Outlay Deposit PaymentHiddenMatter Email HiddenReference Number Payment Option(Required)Bank TransferCredit CardTrust Account DetailsAccount – bytherules Conveyancing Pty Ltd Trust Account CBA Bank BSB – 064 449Account – 1047 9564 Please use the below reference number: Credit Card Type(Required) American Express MasterCard Visa please note this includes the credit card fee of 1.8%Deposit Outlays Price: The outlay deposit is used to pay for disbursement costs we may incur on your behalf. Any balance is returned at settlement.Deposit Outlays Price: The outlay deposit is used to pay for disbursement costs we may incur on your behalf. Any balance is returned at settlement.Credit Card(Required) American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Exp Month010203040506070809101112 Year Exp Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name