Community Infrastructure Levy (CIL)
Form 3: Withdrawal of Assumption of Liability
Please complete the form using block capitals and black ink and send to the Charging Authority (or Collecting Authority if this differs from
the Charging Authority).
Planning Permission / Notice of Chargeable Development Reference:
Site address:
Description of development:
Details of Development
Name and Address of Party Withdrawing Assumption of Liability
Title:
First name:
Last name:
Company registration no:
(where applicable)
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
Company
(optional):
House
number:
House
name:
House
suffix:
Unit:
Position:
Email address (optional):
Extension
number:
National number:
Country code:
Telephone number
I/we confirm that I/we have copied this form to the following interested parties:
Landowner/s Leaseholders Any other parties who has/ve jointly assumed liability
for guidance on CIL generally, including assuming liability.See
This form must be submitted to, and received by, the Charging/Collecting Authority prior to Commencement of Development.
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Planning Practice Guidance for CIL
I/we hereby withdraw my/our assumption of liability for the Community Infrastructure Levy charge for the above development. I/we
confirm that this withdrawal has been made prior to commencement of the development. This statement has been made in good faith.
I/we understand that withdrawing this assumption of liability will annul any social housing relief which has been granted on this
chargeable development.
Date (DD/MM/YYYY):
Signed - Party withdrawing assumption of liability:
Declaration
It is an offence for a person to knowingly or recklessly supply information which is false or misleading in a material respect to a charging or
collecting 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.
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