File Number

RT ......./..........	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

RESIDENTIAL TENANCY
RESPONSE/SUBMISSIONS FORM

 
APPLICANTS Name:

RESPONDENT’S/Lessor/Tenants  DETAILS	
 Name		
Address line 1		
Address line 2		
Telephone:		
Email:		
Fax:		
RESPONDENT’S REPRESENTATIVES DETAILS (IF ANY)	
Name		
Address line 1		
Address line 2		
Telephone		
Email		
Fax		

Statement contesting/defending application.
I dispute the applicant’s claim on the following grounds (please attach page if insufficient space):
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If the respondent has a counterclaim or set-off a fee is payable when filing the response.
Counterclaim [or 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 of respondent or respondent’s representative 	

Name of respondent or respondent’s representative:___________________________