File Number

            /
	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

DAMAGES 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:	

Grounds of application (set out briefly the grounds of the application)	

	

	

	

	

	

	

	

	

	

	

Previous attempts to resolve the dispute 	
*The applicant and the respondent have attempted to resolve their dispute in the following way:	

	

	

	

	
	
*The applicant and respondent have made no prior attempts to resolve their disputes	
Remedy sought (Please describe here the details of any orders you are seeking and also the details of any amounts that you seek compensation for as a result of the trespass).	

	

	

	

	
Amount	Reason claimed	
 	Fee for commencing proceedings	
	Charges and out-of-pocket expenses	
	Amount of damages claimed	
	AND INTEREST IS CLAIMED	
	TOTAL AMOUNT OF APPLICATION	

Applicant’s signature			Date		

INFORMATION ABOUT DAMAGES APPLICATIONS

This Application form should be used for applications to the ACT Civil and Administrative Tribunal (the ACAT) for damages. 

A ‘damages application’ is an application to recover damages caused by someone else’s actions.

Other applications should be lodged in person between the hours of 9am and 4.30pm at the ACAT, ACT Magistrates Court Building, Knowles Place, Canberra City or by mail to GPO Box 370, Canberra ACT 2601 or by fax to (02) 6205 4855