QLeave

                                                                                                QLeave levy number: S-0028806



Notification and Payment Confirmation
This form is to confirm that the levy or first instalment of the levy has been paid, that an exemption from payment of the levy
exists in relation to the work, or that an exemption from immediate payment of levy exists in relation to the work, in accordance
with section 77(2) the Building and Construction Industry (Portable Long Service Leave) Act 1991 (BCI Act). Form BCI 14 v10.

PROJECT DETAILS

                                                                                  Date paid:             21/11/2025
 Internal job reference number    Q44192/155
                                                                                                         Levy payer: CORAL
 (if applicable):
 Project owner:                   -                                                                      HOMES QLD PTY LTD
 Principal contractor:            CORAL HOMES QLD PTY LTD
 Certifier:                       Suncoast building approvals

 BUILDING AND CONSTRUCTION WORK DETAILS
 Start date:                      17/12/2025                                      Project finish date:   17/10/2026
 Building and construction        DWELLING - HOUSE
 work description:
 Lot no:                          2                                               Plan no:               RP179073
 Building and construction        320 Black Mountain Road
 work address:                    -
 Suburb:                          BLACK MOUNTAIN QLD                              Postcode:              4563

 LEVY DETAILS
 Total cost of work (GST excl):                        $720,060.00
 Total exempted cost of work (GST excl):                     $0.00
 Total levy paid:                                        $4,140.00

 CONTACT QLEAVE
 Suite 3, Lot 1/62 Crockford St, Northgate QLD 4013 | PO Box 348, Archerfield BC QLD, 4108

 Freecall 1800 803 481 | Email [email protected] | www.qleave.qld.gov.au


 BUILDING AND CONSTRUCTION WORK COMPLETED

 When the building and construction work reaches practical completion, you are invited to submit your final costs and
 completion date to QLeave. If the final cost of work is $50,000 or more than originally notified you must notify QLeave and
 pay any additional levy within 30 days of work ending. Failure to provide these details will result in the commencement of
 enforcement action. To provide QLeave with these details please complete the finalisation form on the portal.