Adjudication Application Form – Queensland For BCIPA Claims

Below is the Adjudication Application Form For Queensland BCIPA Claims.

If you have prepared your submissions and evidence supporting your claim, fill out the form below / attached and send it to us together with your payment claim, second notice (if any) and payment schedule (if any), submissions and supporting evidence for our review and lodgement.

If you would like assistance writing submissions and compiling supporting evidence, fill out the form below / attached and send it to us together with your payment claim, second notice (if any) and payment schedule (if any) and we will prepare your entire adjudication application for you, lodge it and manage it throughout the entire process.

Download Application Form in MS Word here

APPLICATION FOR ADJUDICATION FORM (QLD)

Building and Construction Industry Payments Act 2004 QLD

CLAIMANT:

[vc_table vc_table_theme=”default”][]Name%3A,[b]%5BXxxxxx%20Xxxxxxx%20Pty%20Ltd%5D|ABN%3A,%5B12%20123%20123%20123%5D|ACN%3A,%5B123%20123%20123%5D|Address%3A,%5B123%20Name%20Street%2C%20Brisbane%20QLD%204000%5D|Phone%20No.,%20%5B02%201234%201234%5D|Email%3A,%5Bxx%40xx.com.au%5D[/vc_table]

The claimant will serve a copy of this adjudication application (including all attachments) on the respondent on the same day as it is lodged. If it is not served on the same day the Applicant will immediately notify the Adjudicator of the date of service upon the respondent.The claimant hereby applies for adjudication under the Building and Construction Industry Payments Act 2004 QLD of the referenced Payment Claim.

Signed (claimant): …………………………………. Date: [Day Month Year]

RESPONDENT:

[vc_table vc_table_theme=”default”][]Name%3A,[b]%5BXxxxxx%20Xxxxxxx%20Pty%20Ltd%5D|ABN%3A,%5B12%20123%20123%20123%5D|ACN%3A,%5B123%20123%20123%5D|Address%3A,%5B123%20Name%20Street%2C%20Brisbane%20QLD%204000%5D|Phone%20No.,%20%5B02%201234%201234%5D|Email%3A,%5Bxx%40xx.com.au%5D[/vc_table]

CONTRACT DETAILS:

[vc_table vc_table_theme=”default”]Project%20Name%3A,[b]%5Bsite%20address%5D|Contract%20Title%3A,%5BPerson%20instructing%20%2F%20Purchase%20Order%20No%20%2F%20Contract%20No%20%2F%20etc%5D[/vc_table]

PAYMENT CLAIM DETAILS:

[vc_table vc_table_theme=”default”][]Claimant’s%20business%3A,[]%5Bie.%20plumbing%5D|[]Payment%20claim%20amount%3A,[]%5B%249%2C876.54%5D|[]Due%20date%20for%20payment%3A,[]%20%5BDay%20Month%20Year%5D[/vc_table]

PAYMENT SCHEDULE DETAILS:

[vc_table vc_table_theme=”default”]Date%20payment%20claim%20served%20on%20respondent%3A,%5BDay%20Month%20Year%5D|Date%20payment%20schedule%2C%20if%20any%2C%20served%20on%20claimant%3A,%5BDay%20Month%20Year%5D|Scheduled%20amount%20(amount%20that%20respondent%20proposes%20to%20pay)%3A,%5BNil%20-%20%249%2C876.54%5D[/vc_table]

Please note: there is no application fee

ADJUDICATION APPLICATON SUBMISSIONS AND SUPPORTING DOCUMENTS: Provided with and forming part of this Adjudication Application are the Claimant’s submissions and supporting documents per itemised list below: