3. Proposed Use
Intended Use (please detail each proposed use)
Gross internal new build floorspace of each
intended use (m
2
)
Notes: Note: Gross internal floorspace is the internal area of the building, and should include
circulation and service space such as lifts and floorspace devoted to corridors, toilets, storage, etc.
4. Declaration
I/we confirm that the details given are correct.
Signed (must be the same signatory as application form):
Scanned Signature (Optional)
Print Name
Date Signed
Please note unless a subsequent change to the floorspace is agreed by the Council, the information
within this form will be used to calculate the amount of CIL payable, and which will be set out in
subsequent notices issues by the Council relating to its collection. It is an offence for a person to
knowingly or recklessly supply information which is false or misleading in a material respect to a
collecting or charging authority in response to a requirement under the Community Infrastructure
Levy Regulations (2010) as amended (regulation 110, SI 2010/948). A person guilty of an offence
under this regulation may face unlimited fines, two years imprisonment, or both.
5. Declaration - Assumption of Liability
I/we am/are the person(s) detailed at section 1 and I/we would like to assume liability for payment of any
applicable Community Infrastructure Levy under regulation 31 of the Community Infrastructure Levy
Regulations (2010) as amended. I/we hereby assume liability for the Community Infrastructure Levy charge
for the above development. I/we understand that I/we must submit a Commencement Notice in order to
secure the payment periods as set out in the District Council's adopted Instalment Policy. I/we am/are aware
of the surcharges I/we will incur if I/ we do not follow the correct procedures for paying the CIL charge. I/we
understand any communication and actions by the collecting authority to pursue me/us for the assumed
liability will be copied to the site land owners (as defined in CIL regulations).
Scanned Signature (Optional)
Print Name
Date Signed
If you wish to assume liability at a later date, please complete an `Assumption of Liability' form prior to
commencement of development. If you are a charitable institution or social housing provider and believe you
could benefit from exemption or relief, please complete a `Request for Claiming Exemption or Relief' form
which is available on the Councils website - www.newark-sherwooddc.gov.uk/cil/
