File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR A REPAIR
COST DETERMINATION
		
	Common Boundaries Act 1981, section 6(3)		

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	On__________________________, the fence separating the applicant’s land and the respondent’s land was *[damaged/destroyed]. 

*4	It was necessary to *[repair/replace] the fence without delay to protect people living in premises on the *[applicant’s/respondent’s] land. 

*4	It was necessary to *[repair/replace] the fence without delay to prevent the escape of animals from the *[applicant’s/respondent’s] land. 

5	The applicant *[repaired/replaced] the fence at a cost of $                      .

6	On_____________________________, the applicant requested the respondent to contribute to the cost of the *[repair/replacement] of the fence.

Date:

(signature of applicant or applicant’s representative)

(name of applicant or applicant’s representative)