File Number

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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

CONTRACT APPLICATION- 
CIVIL DISPUTE

APPLICANT’S DETAILS	
Name	 
	
Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
APPLICANT’S REPRESENTATIVES DETAILS (IF ANY)	
Name

Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
RESPONDENT’S DETAILS	
 Name		
Address line 1		
Address line 2		
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
Telephone	                                                                    Fax:                                       
Email:	

Details of dispute (set out the details of the contract and the dispute) 
*You MUST specify when the contract was made and when the dispute arose	

	

	

	

	

	
	
Remedy sought (Please describe here the details of any orders you are seeking and also the details of any amounts that you seeking for compensation).	

	

	

	
Amount	Reason claimed	
 	Fee for commencing proceedings	
	Charges and out-of-pocket expenses	
	Amount claimed in dispute	
	AND INTEREST IS CLAIMED	
	TOTAL AMOUNT OF APPLICATION	
Applicant’s signature			Date