File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR A REPAIR
DETERMINATION
		
	Common Boundaries Act 1981, section 5(2)		

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:	
Details of application
*omit if, or whichever is, inapplicable
1	The applicant occupies land situated at________________________________                        
           
 ,being block_______________, section___________, division 

of___________                                  
            (the applicant’s land).
2	The respondent occupies land situated at___________________, being 

block________, section____________________, division of______________
(the respondent’s land).

3	The applicant proposes that the fence separating the applicant’s land and the respondent’s land be *[repaired/replaced].  Particulars of the proposed *[repair/replacement] of the fence are as follows:

4	The cost of the proposed *[repair/replacement] of the fence is $                    .  The applicant proposes that the respondent contribute $                     .

5	On___________________________, the applicant gave the respondent a notice in writing requesting the respondent to discuss the *[repair/replacement] of the fence between the applicant’s land and the respondent’s land.

*6	The respondent has refused to join in the *[repair/replacement] of the fence.

*6	The applicant and respondent have not been able to agree upon the following matters:(set out the matters that cannot be agreed)

Date:

(signature of applicant or applicant’s representative)

(name of applicant or applicant’s representative)