Present at tribunals

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Residential Tenancies List

Civil Division

Office use only

Act section/s Notice Expiry Date

General Application

Residential Tenancies List, Victorian Civil and Administrative Tribunal

03 9628 9800 http://www.vcat.vic.gov.au

Fields marked with an asterisk (*) must be completed.

Do you need to complete this form?

- Please read the following guide before completing this form:

Residential Tenancies List Application Guide

- Use this form if you are a landlord, tenant, caravan park owner or resident or rooming house owner or resident and wish to have VCAT hear your dispute. - You must send a copy of this completed application to all other parties to the proceedings. - If you do not understand any of the questions on this form please refer to the above Residential Tenancies List Application Guide. VCAT's website also has useful information including video footage showing how hearings are conducted and access to legislation, please refer to the VCAT website. - For any other tenancy advice and assistance contact the Consumer Affairs Helpline on 1300 558 181.

Applicant details

Who is the applicant? *

Landlord Tenant Rooming house owner Rooming house resident Caravan park owner

Caravan park resident Site owner Site tenant

Is the applicant an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the applicant is an individual)

Title * Surname * Given name 1 Given name 2

Organisation (if the applicant is an organisation)

ABN Organisation name *

Company (if the applicant is a company)

ACN Company name *

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Address

(PO Box is insufficient) If you have a representative, you can provide your representative's address and all correspondence will be sent to your representative's address.

Street address *

Suburb / Town * State * Postcode *

Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

If you are submitting the application online, a confirmation receipt will be sent to this email address. This email address can be your representative's email address.

Email

Who is the applicant? *

Landlord Tenant Rooming house owner Rooming house resident Caravan park owner

Caravan park resident Site owner Site tenant

Is the applicant an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the applicant is an individual)

Title * Surname * Given name 1 Given name 2

Organisation (if the applicant is an organisation)

ABN Organisation name *

Company (if the applicant is a company)

ACN Company name *

Address

(PO Box is insufficient) If you have a representative, you can provide your representative's address and all correspondence will be sent to your representative's address.

Street address *

Suburb / Town * State * Postcode *

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Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

If you are submitting the application online, a confirmation receipt will be sent to this email address. This email address can be your representative's email address.

Email

Do you have a representative? * Yes No

(This may be an agent, tenant support worker, advocate etc.)

If yes, please enter the details in the next section.

Applicant's representative details

Is the representative an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the representative is an individual)

Title * Surname * Given name 1 Given name 2

Organisation (if the representative is an organisation)

ABN Organisation name *

Company (if the representative is a company) ACN Company name *

Is this address the same as provided in the Applicant's details section? Yes No

If no, please enter address below.

Address

(Please note, if there is a named representative all correspondence will be sent to the representative’s address.)

Street address *

Suburb / Town * State * Postcode *

Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

Email

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Respondent details

Who is the respondent? *

Landlord Tenant Rooming house owner Rooming house resident Caravan park owner

Caravan park resident Site owner Site tenant Database operator

Is the respondent an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the respondent is an individual)

Title * Surname * Given name 1 Given name 2

Organisation (if the respondent is an organisation)

ABN Organisation name *

Company (if the respondent is a company)

ACN Company name *

Address (If you do not know the respondent's address, please insert the address of their representative and all correspondence will be sent to the representative's address. PO Box is insufficient.) Interstate respondents

Commonwealth legislation requires applicants to take additional steps prior to serving an application where the respondent lives interstate. Please contact VCAT for further information and documents.

Street address *

Suburb / Town * State * Postcode *

Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

Email

Who is the respondent? *

Landlord Tenant Rooming house owner Rooming house resident Caravan park owner

Caravan park resident Site owner Site tenant Database operator

Is the respondent an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the respondent is an individual)

Title * Surname * Given name 1 Given name 2

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Organisation (if the respondent is an organisation)

ABN Organisation name *

Company (if the respondent is a company)

ACN Company name *

Address (If you do not know the respondent's address, please insert the address of their representative and all correspondence will be sent to the representative's address. PO Box is insufficient.) Interstate respondents

Commonwealth legislation requires applicants to take additional steps prior to serving an application where the respondent lives interstate. Please contact VCAT for further information and documents.

Street address *

Suburb / Town * State * Postcode *

Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

Email

Does the respondent have a representative? * Yes No

(This may be an agent, tenant support worker, advocate etc.)

If yes, please enter the details in the next section.

Respondent's representative details

Is the representative an individual, an organisation or a company? * Individual Organisation Company

Org ID (Office use only)

Name (if the representative is an individual)

Title * Surname * Given name 1 Given name 2

Organisation (if the representative is an organisation)

ABN Organisation name *

Company (if the representative is a company)

ACN Company name *

Is this address the same as provided in the Respondent details section? Yes No

If no, please enter address below.

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Address

(Please note, if there is a named representative all correspondence will be sent to the representative’s address.)

Street address *

Suburb / Town * State * Postcode *

Contact details

Please provide at least one phone number

Business phone ( )

Area code Number

After hours phone ( )

Area code Number

Mobile

Number

Fax number ( )

Area code Number

Email

Address of the rented premises (or room or site if applicable)

Address

Street address *

Suburb / Town * State * VIC

Postcode *

Previous or pending residential tenancies list file number/s

If VCAT has dealt with other disputes involving the same Applicant/s and Respondent/s or if there are other related matters to be heard by the Tribunal please insert the file number(s) here:

VCAT file number VCAT file number VCAT file number

Bond details

Was a bond paid? * Yes No

If yes, please enter details below.

Bond number Amount paid ($)

Tenant A's name

Tenant B's name

Tenant C's name

Director of Housing

Total amount paid

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Claim details - What do you want VCAT to do?

This section tells the Tribunal and other parties what orders you are wanting the Tribunal to make. The correct wording is provided in the Application Guide for your assistance. Please refer to the claim details section in the Guide. *

You must give complete details about your claim so that the respondent is able to understand why you have made the application. If compensation is sought you must set out each amount that is claimed. If you do not provide enough information, your case may be dismissed or adjourned. If you need more space, print clearly on a separate piece of paper and attach to this application. *

Hearing arrangements

If you believe that security may be needed at the hearing, please contact the Tribunal immediately after you have lodged your

application in order to have satisfactory arrangements made.

Does the Applicant or Respondent require an interpreter at the hearing? * Yes No

Name of person requiring an interpreter

Title * Surname * Given name 1 Given name 2

Language/dialect *

Does any person at the hearing require any other special assistance? * Yes No

Please specify what special assistance is required *

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Service of application to Respondent

You must serve a copy of this application to the respondent.

Date of service to the respondent Method of service to the respondent.

By hand By mail By registered mail

Supporting documents

You must provide documents that support your application. For further information, please refer to the Application Guide.

Prescribed Form(s)

This can include a Notice to Vacate, Notice to Leave, Breach of Duty Notice.

Condition Report(s)

This can be the copy of the Condition report.

CAV Report(s)

This can be a copy of the non urgent repairs report, rental increase report.

Bond Receipt(s)

This can be the copy of the Bond receipt from the RTBA.

Other supporting documents

Other supporting documents including a copy of the Rooming House Rules, Caravan Park Rules, Notice of intention to vacate by the tenant, copies of quotations, accounts or receipts for proof of claim, affidavits in support under sections 339, 344 or 414.

If providing attachment electronically, please supply as: docx;xls;doc;pdf

Payment details

Which Act/s are you making this claim under? *

(Please note if you are applying under more than one Act, the higher application fee will apply).

Residential Tenancies Act 1997; except Part 10 (for most applications, you will tick this box)

Fair Trading Act 1999, Australian Consumer Law and Fair Trading Act 2012 & Owners Corporations Act 2006; where claim is for a sum less than $500

Fair Trading Act 1999, Australian Consumer Law and Fair Trading Act 2012 & Owners Corporations Act 2006; where claim is for a sum of $500 or more but less than $10,000

Fair Trading Act 1999, Australian Consumer Law and Fair Trading Act 2012 & Owners Corporations Act 2006; where claim is for a sum of $10,000 or more but less than $100,000 or where the claim has no monetary value

Fair Trading Act 1999, Australian Consumer Law and Fair Trading Act 2012 & Owners Corporations Act 2006; where claim is for a sum of $100,000 or more but less than $1 Million

Fair Trading Act 1999, Australian Consumer Law and Fair Trading Act 2012 & Owners Corporations Act 2006; where claim is for a sum of $1 Million or more

Housing Act 1983

Landlord and Tenant Act 1958

Residential Tenancies Act 1997; Part 10 (bond only application)

You must pay the relevant application fee at the same time you lodge this form. Fees may change each year. To find out about the current fee for this application see the attached fee schedule below. To find out whether you are entitled to a fee waiver, visit the VCAT website.

Fee schedule

Fee Waiver

Are you applying for a fee waiver? * Yes No

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Concession Card Holders If you are a concession card holder, please complete the application for fee waiver concession card holder form and attach to this application and include copies of evidence to support your claim. Financial Hardship If you are applying for a waiver of fees due to financial hardship please complete and attach the declaration in the application for waiver of fees by reason of financial hardship form. Please note if there is more than one applicant each applicant should fill out the appropriate application form. For copies of the fee waiver application forms and for further information please visit the VCAT website.

Payment can only be made via the following methods: - Online by Credit Card (Payment can be made online after you have submitted the form). - By mail, cheque or money order made out to the Victorian Civil and Administrative Tribunal or using a credit card, please complete a Payment by Credit Card form (Link provided below). - In person at the Ground Floor, 55 King Street Melbourne, you can pay over the counter by credit card, cash, eftpos, cheque or money order made out to the Victorian Civil and Administrative Tribunal. - By fax, (you can only pay by credit card using this method), you will also need to complete a Payment by Credit Card form (Link provided below).

Payment by credit card form

Acknowledgement

I understand and acknowledge that: • To the best of my knowledge, all information provided in this application is true and correct and that no details relevant to the application

have been left out. • I approve the information that has been provided. • It is an offence under section 136 of the Victorian Civil and Administrative Tribunal Act 1998 to knowingly give false or misleading

information to VCAT. • I further undertake to give or send a copy of this completed application form to the respondent(s) named in this application. I will notify VCAT as soon as possible in the event that for some reason I am unable to do so.

By ticking this checkbox I confirm that I have read and understood all the statements above *

Full name of person completing this application * Date *

Signature of person completing this application *

Privacy statement

The information collected in this application will be used to assess the application and determine eligibility to initiate a proceeding at the Victorian Civil and Administrative Tribunal (VCAT). The Victorian Civil and Administrative Tribunal Act 1998 governs what information is available to the public. The Information Privacy Act 2000 (the Act) and the Victorian Privacy Principles set out the requirements that persons must abide by. Section 10 of the Act refers to Courts and Tribunals and the exemptions that apply to them. For further information regarding VCAT's privacy policy, please visit the VCAT website.

Additional information

VCAT will send you and all the other parties a notice of hearing. The notice will tell you the venue, time and date you must come to the hearing. Bring your copy of the application form and any documents to the hearing. This may include the tenancy agreement, condition report, bond receipt and photos.

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Lodgement

You can lodge this completed form and any attachments online or by:

Mailing it to:

Victorian Civil and Administrative Tribunal Residential Tenancies List GPO Box 5408 Melbourne VIC 3001

Delivering it in person to:

Victorian Civil and Administrative Tribunal Residential Tenancies List Ground Floor, 55 King Street Melbourne VIC 3000

Office hours: 9am - 4.30pm Monday to Friday (closed public holidays)

Faxing it to:

03 9628 9822

Telephone: 03 9628 9800

Email: [email protected]

Website: http://www.vcat.vic.gov.au