File Number

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	        ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

  APPLICATION TO SET ASIDE 
   EX-PARTE ORDER AND STAY PROCEEDINGS

APPLICANT	
Name:		
RESPONDENT	
Name:		
THIS APPLICATION is made by the: (strike out below what does not apply)    	
Applicant                                                Respondent                                                     All Parties	

The Applicant / Respondent applies for the following orders or directions:  ( * Cross out what’s not applicable)

1.	* That the order of the Tribunal made on the  ______ day of _______________ 20___ be set aside

2.	* That the matter be restored to the list

3.	* That enforcement be stayed until further order of the Tribunal

4.	* (any other orders or orders sought)
	
Grounds relied on: (use an attachment if insufficient space)	

	

	

	

Date:  ____/____/_____                                                                            Signed;________________________
                                                                                                                                   Applicant / Respondent	
This application has been set down for determination by the Tribunal at: …………………......................................................................................................................................
on the..................................... day of .................................... ........... 20...........
at ..........O’clock in the forenoon/afternoon, or so soon thereafter as the course of business permits.

								.........................................................									[signed]       DEPUTY REGISTRAR

								.........................................................
									         (Date)