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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

STATEMENT OF INTEREST CLAIMED- CIVIL DISPUTE
		
	This statement is to be attached to the Civil Dispute Application/Declaration to commence proceedings before the Tribunal		

PLEASE TICK THE APPROPRIATE BOX	
Interest is claimed to be calculated in accordance with the Court Procedures Rules 2006.		
Interest is claimed in accordance with the contract between the applicant(s) and the respondent		
Debt amount	Period of interest	Number of days	Interest rate	Interest	

					

					

					

					

					

					

					
		TOTAL AMOUNT OF INTEREST ACCRUED TO DATE	

Applicant’s signature			Date