File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR DISCIPLINARY ACTION*

	*for applications under authorising laws noted on attachment		
APPLICANT’S DETAILS	
Name

Address Line 1	
 	
Address Line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
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	
 	
Telephone	                                                                    Fax:                                       
Email:	
Interim or emergency orders sought (use an attachment if insufficient space) 	

 	

Final orders sought (use an attachment if insufficient space)	

 	
Charge (if applicable; e.g., under the Legal Profession Act 2006)	

 	

Legislative provisions under which action is brought (a list of authorising laws is attached)	

	

Grounds or allegations relied on (use an attachment if insufficient space. Provide a summary only. Details should be provided in an accompanying affidavit or statement)	

	

	

	

	

	

	

	

	

	

	

	

	
Applicant’s signature	  Date  

 	

ACT CIVIL & ADMINISTRATIVE TRIBUNAL

APPLICATION FOR DISCIPLINARY ACTION ATTATCHMENT

This Application form should be used for applications to the ACT Civil and Administrative Tribunal (the ACAT) for disciplinary action or occupational discipline under the following authorising laws:

Health Professionals Act 2004
Legal Profession Act 2006
Security Industry Act 2003
Agents Act 2003
Consumer Credit (Administration) Act 1996
Sale of Motor Vehicles Act 1977
Tobacco Act 1927
Architects Act 2004
Surveyors Act 2007
Construction Occupations (Licensing) Act 2004
Liquor Act 1975

Applications brought under the Security Industry Act 2003 and the Agents Act 2003 should be lodged in person between the hours of 9am and 4:30pm Monday to Friday at the office of ACAT at Level 4, ACT Health Building, 1 Moore Street in Canberra or by mail to GPO Box 158, Canberra ACT 2601 or by fax to (02) 6207 7739.

Other applications should be lodged in person between the hours of 9am and 4:30pm at the ACAT, Level 4, ACT Health Building, 1 Moore Street, Canberra City or by mail to GPO Box 370, Canberra ACT 2601 or by fax to (02) 6205 4855.