File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR VARIATION
OF DETERMINATION
		
	Common Boundaries Act 1981, section 14		

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:	
The applicant applies for a variation of the determination made by the ACAT on
 
 ____________________________ in relation to the *[erection/repair/replacement] 

of a fence between block________________, section__________ , division of 

______________ (the applicant’s land) and block____________ , section________,                                             

division of ______________________ (the respondent’s land).

Details of Variation Sought
(set out the details of the variation sought)
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Date:

(signature of applicant or applicant’s representative)

(name of applicant or applicant’s representative)