Version 2019
This form should be saved to your device and then completed using the free Adobe Acrobat
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Community Infrastructure Levy (CIL)
Form 3: Withdrawal of Assumption of Liability
This form must be submitted to, and received by, the Collecting Authority prior to Commencement of Development.
Please note: This version of the form should only be used for submissions relating to planning applications in England.
There is a legacy version of the form for use in Wales:
Please complete the form using block capitals and black ink and send to the Collecting Authority.
for guidance on CIL generally, including assuming liability.See
Privacy Notice
This form is provided by Planning Portal and based on the requirements provided by Government for the sole purpose of submitting
information to a Local Authority in accordance with the 'The Community Infrastructure Levy Regulations 2010 (as amended).
Please be aware that once you have downloaded this form, Planning Portal will have no access to the form or the data you enter into it
(unless you choose to upload it to any Planning Portal online service in agreement with the relevant terms and conditions). Any subsequent
user of this form is solely at your discretion, including the choice to complete and submit it to a Local Authority in agreement with the
declaration section.
Upon receipt of this form and any subsequent information, it is the responsibility of the Local Authority to inform you of its obligations in
regards to the processing of this information. Please refer to its website for further information on any legal, regulatory and commercial
requirements relating to information security and data protection of the information you have provided.
Planning Permission / Notice of Chargeable Development Reference:
Site address:
Description of development:
Details of Development
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Download the legacy version of this form
Planning Practice Guidance for CIL
Version 2019
Name and Address of Party Withdrawing Assumption of Liability
First name:
Last name:
Company registration no:
(where applicable)
Address 1:
Address 2:
Address 3:
Email address (optional):
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:
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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