File Number

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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

RESPONSE TO THIRD PARTY NOTICE- CIVIL DISPUTE

RESPONDENT’S DETAILS	
Name	 
	
Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
RESPONDENT’S REPRESENTATIVES DETAILS (IF ANY)	
Name

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

ACN/ABN

Address of registered officer/public officer		
		
Telephone	                                                                    Fax:                                       
Email:	

Admission of liability
I admit liability (in whole or in part) and agree to the entry of judgment on the following terms:
Judgment is to be entered in the amount of:	$	
The following amount is paid into the Court:	$	
The amount of the judgment is to be paid on or before 

The amount of the judgment is to be paid by instalments on the following terms:		
The following orders are to be made:
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If liability is not admitted
Disputed claim
I dispute the respondent’s claim on the following grounds: (attach page if insufficient space)
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If the third party has a counterclaim or set-off
Counterclaim [and set-off]
The following counterclaim and set-off is made:	$	
Set out briefly the grounds of the counterclaim and set-off
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Date:____________________

Signature:___________________________

Name:______________________________