Form 3.61	Arbitration—third-party notice
Court Procedures Rules 2006
(see r 3920 (Arbitration—including other parties))
In the Magistrates Court of the Australian Capital Territory

No WC		of (year) 

(name)
Applicant

(name)
Respondent

To:

Third party 
respondent	name		
	address		ABN 	
Nature of notice
	the respondent claims to be entitled to be indemnified by you against liability to pay compensation to the applicant (Workers Compensation Act, s 13 (Subcontracting)) on the ground that at the time of the injury for which compensation is claimed the applicant was immediately employed by you in the execution of work undertaken by the respondent in relation to which the respondent had contracted with you for execution of the work by or under you 
	the respondent claims to be entitled to contribution from you in relation to compensation claimed by the applicant from the respondent in respect of a disease (Workers Compensation Act, s 27 (Compensation for death or incapacity through disease)) on the ground that you employed the worker in employment that caused or contributed to the disease before the liability of the respondent arose
	Other (state nature of notice)

Date:

(signature of applicant or applicant’s solicitor)
(name of applicant or applicant’s solicitor)

Notice to third-party respondent
You must give a copy of this third-party notice to your insurer not later than 7 days after the day you are served with the notice.
You may file an answer to this third-party notice in the Court not later than 28 days after the day the notice is served on you (see r 3913 (Application for arbitration—answer by respondent or third-party respondent).
If you do not file an answer within this time, you are liable to have an order made against you.

Registrar
	copy of application for arbitration attached
	copy of respondent’s answer attached
(Tick each applicable box)