File Number

            /
	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR RESOLUTION OF TENANCY DISPUTE 

		

APPLICANT/s: 	

Address: 		

Are you the: 	 Lessor 	Grantor  	 Tenant 	Occupant  	

Telephone Contact: 	
Facsimile Contact: 	
EMAIL Address: 	

RESPONDENT/s: 	

Address: 		

Is the Respondent the :   Lessor 	Grantor  	 Tenant 	Occupant  

Telephone Contact: 	
Facsimile Contact: 	
EMAIL Address: 	

THE APPLICANT APPLIES FOR THE FOLLOWING ORDERS

	Termination of Tenancy Agreement.   	   Rental Arrears
	Termination of Occupancy Agreement.	  Compensation/Damages
	Rental Bond Dispute
	For the resolution of any other dispute - namely:- 

DISPUTE RESOLUTION:

Have the parties attempted to resolve this dispute through any formal mediation processes.

YES:  	 NO:  	

PREMISES:

Address of Premises in Dispute:

What sort of Agreement is there	 TENANCY AGREEMENT
between the parties: 			 OCCUPANCY AGREEMENT
		 
.	A tenancy agreement is an agreement between a lessor and a tenant.  
           It can be in writing, oral or implied and is governed by the standard 
           residential tenancy terms.
.	An occupancy agreement is an agreement between a grantor and an
            occupier for the occupier to reside in a premises. Boarders, lodgers
            and caravan park occupants are just some parties who are residing
                        under an occupancy agreement.

ARE THERE any other people living in the premises who would be affected by any order that may be made by the Tribunal?   YES          NO

If YES, please name them: .....................................................................................
			..................................................................................................
			.................................................................................................			

BOND DETAILS:

Was a Bond paid?  				 YES          NO		

Amount of Bond: $ 				Date Bond Paid: 

Bond lodged with Office of Rental Bonds: 	 YES          NO

Date Bond Lodged: 				Rental Bond Number: 

Has the Bond been Released?	 	 YES          NO	    PARTIAL

If Yes, to whom?	 Lessor/Grantor          Tenant/Occupant	   

Amount still in dispute:

The Tribunal will endeavour to hear and determine this application within 14 days of the application being served upon the other party (the respondent/s).

Please advise the Tribunal in the space below if there is anything that may stop you from appearing in person before the Tribunal for a hearing or conference or of any dates that you will be unavailable to attend before the Tribunal

	I will be able to appear before the Tribunal on any date provided.

	I will be able to appear before the Tribunal, however I will not be available on the following dates:

 	I will not be able to appear before the Tribunal in person;

HOWEVER

 	I will be represented before the Tribunal by: ...................................................
	(NOTE:  If the person representing you is not a solicitor you must provide the      
            Tribunal with an authority for that person to act on your behalf.  This includes 
            representation by a real estate agent)
	
My representative can be contacted at:

Address: 		..................................................................................................
			..................................................................................................
			..................................................................................................
Telephone Contact: 	..................................................................................................
Facsimile Contact: 	..................................................................................................
[PLEASE NOTE: THE TRIBUNAL WILL CONDUCT PROCEEDINGS BETWEEN 9.00 AM & 5.00 PM MONDAY TO FRIDAY]
NOTE:

A DETAILED STATEMENT OF PARTICULARS IS TO BE INCLUDED WITH YOUR APPLICATION.

The statement of particulars should identify the issues in dispute, the nature of relief sought and the reasons why.  The application should include receipts, statements and any other relevant material regarding the dispute and the residential tenancy or occupancy agreement.  A checklist is attached to assist you with this requirement.

YOU MUST LODGE THE ORIGINAL PLUS TWO COPIES OF YOUR APPLICATION AND SUPPORTING DOCUMENTS WITH THE TRIBUNAL.  ONE OF THE COPIES WILL BE FORWARDED TO THE RESPONDENT.  ANY CONFIDENTIAL INFORMATION SHOULD THEREFORE NOT BE INCLUDED WITH YOUR APPLICATION.

DATED				

...........................................................................................
					APPLICANT/S

STATEMENT OF PARTICULARS

1	Please Identify the Issues In Dispute, for example, payment of rental arrears or that the lessor/grantor fix a broken heater.
..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

2	Please state the nature of relief you seek (what sort of order you want the Tribunal to make), for example, an order that the tenant/occupant pay rental arrears or the lessor/grantor fix the broken heater.
..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

3	Please give a brief history of the dispute, (why you are making the application)
	If you are claiming money please show calculations and total amount claimed
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................…………
Summary of Particulars	

This form is for the use of Landlords seeking a termination and possession order   

____________________________________________________________   (Landlord/Grantor) (cross out whichever does not apply)

-v-
______________________________________________________________ (Tenant/Occupant) (cross out whichever does not apply)

Tenancy:    
Commencement Date      /       /     Term     fixed (____months _____ years)    periodic

Tenant         in possession  abandoned on     /    /     vacated/returned keys on      /    /	

Service Details
Notice

Date of Notice to Vacate		/        /    
Date notice given by hand	            /       / 	           by _____________________ (name)
(or) date notice posted	                        /       /	           by reg post no. _________________
		(Day of Posting   Sun Mon  Tues  Wed  Thur  Fri  Sat)

Termination date		        /         /    

It is confirmed that the notice has not been withdrawn in writing  

Rent  of $________ per  calendar month fortnight week  day

At date of notice to vacate rent paid to and including		    /        /   

Rent now paid to and including 					    /       / 

Rent Owing 	to 	 today		 date tenant vacated/abandoned 
			
$___________ 	(Calculated as ______ days @ $_____._____ per day)

Bond 
•	provided by			Tenant/Occupant	             $________
					Commissioner of Housing	$________
					__________________	             $________
				Total					$________

•	lodged		             Office of Rental Bonds	(ORB)
                                              not lodged
	(or)		             there is no rental bond

This form is submitted to the Tribunal on        /        /         by ___________________________________ (Name) ( Landlord/Grantor  Agent  Other) who declares that the contents are true and correct.