QUEENSLAND TITLES REGISTRY	CAVEAT	FORM 11 Version 4

Land Title Act 1994 and Water Act 2000	Duty Imprint	Page 1 of 1

Dealing Number
OFFICE USE ONLY Privacy Statement Collection of information from this form is authorised by legislation and is used to maintain publicly searchable records. For more information see the Titles Queensland website.
1. Caveator full name and address for service	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Lot on Plan Description	Title Reference
3. Interest being claimed
4. Grounds of claim
5. Registered owner full name and address	6. Other parties full name and address (eg Mortgagees)
7. Request/Execution a) The Caveator claiming as per item 3 on the grounds detailed in item 4 and subject to the Land Title Act 1994 forbids the registration of any instrument affecting the land described in item 2 until: *this caveat is withdrawn by the Caveator *the completion of the instalment contract mentioned in item 4 (only if Caveat is pursuant to Section 93 of the Property Law Act 2023) #This caveat does not apply to the following instruments:- # Insert dealing number of lodged instrument or identify instrument type by date of execution and name of parties or delete if not applicable. OR b) The Caveator claiming as per item 3 on the grounds detailed in item 4 and subject to the Land Title Act 1994 forbids the entering of the application for adverse possession. * delete if not applicable / / Execution Date Caveator's or Solicitor's Signature Note: A Solicitor is required to print full name if signing on behalf of the Caveator