Community Infrastructure Levy (CIL)
Form 3: Withdrawal of Assumption of Liability
Please complete using block capitals and black ink.
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
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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