Self Build Annex or Extension Claim Form
To be submitted before development commences
Please complete using block capitals and black ink.
Application Details:
Applicant
Name:
Local authority planning application number (if allocated):
Planning Portal Reference (if applicable):
Section A: Claiming Exemption - General Information
To be completed by the individual(s) claiming the exemption.
Please provide the full postal address of the main dwelling (including postcode):
Section B: Nature of exemption
The development is a residential annex within the definition in Regulation 42A(2)
The development is a residential extension within the definition in Regulation 42A(3)
Please tick ONE box
I understand that my claim for exemption will lapse where a commencement notice is not submitted
to the levy collecting authority prior to the commencement of the chargeable development to which
this exemption applies
I declare that the amount of de minimis State Aid received in the last 3 years prior to the submission
of this application for relief is less than 200,000 Euro
I declare that I will occupy the main dwelling as my sole or main residence for a period of 3 years from
completion of the annex/extension.
Please tick ALL boxes
Section C: Self build declaration
I understand the meaning of a 'disqualifying event' for the purposes of a residential annex exemption
(as defined in Regulation 42C) and that where a disqualifying event occurs I must inform the
collecting authority within 14 days
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`Completion' for the purposes of CIL exemption is defined as the issuing of a compliance certificate for this development issued under either
regulation 17 (completion certificates) of the Building Regulations 2010 or section 51 of the Building Act 1984 (final certificates).
`Information about de minimis State Aid for the purposes of CIL exemption can be found here:
I understand that my claim for exemption will lapse where development commences prior to the
collecting authority informing me of its decision.
http://www.planningportal.gov.uk/uploads/1app/forms/140214_state_Aid_extract_FINAL_PDF.pdf
