File Number

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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

THIRD PARTY NOTICE- 
CIVIL DISPUTE

THIRD PARTY DETAILS	
Name	 
	
Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
THIRD PARTYS 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:	

Claim against third party
The applicant has brought a claim against the respondent, particulars of which are stated in the documents served on you with this notice.

The respondent claims against you a contribution or indemnity/claims against you relief as stated in this notice/requires an issue stated in this notice to be decided not only as between the applicant and respondent but also between either of them and you.

Grounds of claim against third-party: (attach page is space insufficient)
Set out briefly the grounds of the claim against the third party
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Relief sought:
Set out relief sought
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Date:___________________________________

Signature:_______________________________

Name:__________________________________