Adjudication Application Form – Victoria For Security Of Payments Act Claims

Below is the Adjudication Application Form For Victoria SOPA 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 VICTORIA

Building and Construction Industry Security Of Payment Act 2002 VIC

CLAIMANT:

Name:[Xxxxxx Xxxxxxx Pty Ltd]
ABN:[12 123 123 123]
ACN:[123 123 123]
Address:[123 Name Street, Melbourne VIC 3000]
Phone No. [02 1234 1234]
Email:[xx@xx.com.au]

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 Security Of Payment Act 2002 VIC of the referenced Payment Claim.

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

RESPONDENT:

Name:[Xxxxxx Xxxxxxx Pty Ltd]
ABN:[12 123 123 123]
ACN:[123 123 123]
Address:[123 Name Street, Melbourne VIC 3000]
Phone No. [02 1234 1234]
Email:[xx@xx.com.au]

CONTRACT DETAILS:

Project Name:[site address]
Contract Title:[Person instructing / Purchase Order No / Contract No / etc]

PAYMENT CLAIM DETAILS:

Claimant\’s business:[ie. plumbing]
Payment claim amount:[$9,876.54]
Due date for payment: [Day Month Year]

PAYMENT SCHEDULE DETAILS:

Date payment claim served on respondent:[Day Month Year]
Date payment schedule, if any, served on claimant:[Day Month Year]
Scheduled amount (amount that respondent proposes to pay):[Nil - $9,876.54]

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: