CCD Form Boarding House Application

March 2017
Adjournment request
CONSUMER AND COMMERCIAL DIVISION
Complete this form to apply to NCAT’s Consumer and Commercial Division for orders under the Boarding Houses Act
2012 to resolve a boarding house dispute.
File Number
Office use only
1. DISPUTE DETAILS
A. WHAT IS THIS DISPUTE ABOUT?
Tick the box that best describes the boarding house dispute.
Occupancy agreement Payment of money Compensation
Occupancy fees or charges Access to goods Termination
B. ADDRESS OF BOARDING HOUSE

Address:
C. BOARDING HOUSE TYPE

General Boarding House (5 or more residents)
Assisted Boarding House (2 or more residents with additional needs)
D. RELATED FILE NUMBERS

List any previous NCAT file numbers relating to the parties and the current dispute: [[NCAT_CustData2|ifnull=ignore]]
Are you making an application that concerns goods or services that you were provided that were funded by the
National Disability Insurance Scheme?
2. APPLICANT
A. APPLICANT TYPE
Tick the box that best describes the person lodging the application to the Tribunal.
Resident Former resident Proprietor Former proprietor
B. APPLICANT’S DETAILS
Provide your details as shown on the occupancy agreement.
Full name: [[FullName|pt=Applicant|ifnull=ignore]]
Postal address: [[MailingAddressLine|pt=Applicant|ifnull=ignore]] [[MailingCity|pt=Applicant|ifnull=ignore]]
[[MailingStateProvince|pt=Applicant|ifnull=ignore]] [[MailingPostCode|pt=Applicant|ifnull=ignore]]
Contact details: Daytime telephone Mobile [[Phone1|pt=Applicant|fm=d|ifnull=ignore]]
Email [[E_Mail|pt=Applicant|ifnull=ignore]]
Do you want NCAT notices and correspondence emailed to you?
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NCAT Consumer and Commercial Division Form | Boarding houses application Page |
By ticking this box you agree to receive the notice of hearing and other future correspondence by email. Please ensure the
email address provided above is accurate and the email account is checked regularly.
3. RESPONDENT
A. RESPONDENT TYPE
Tick the box that best describes the person you are making the applicant against.
Resident Former resident Proprietor Former proprietor
B. RESPONDENT’S DETAILS
Who is the application against? Provide details of person as shown on the occupancy agreement.
Full name: [[FullName|pt=Respondent|ifnull=ignore]]
Postal address: [[MailingAddressLine|pt=Respondent|ifnull=ignore]] [[MailingCity|pt=Respondent|ifnull=ignore]]
[[MailingStateProvince|pt=Respondent|ifnull=ignore]] [[MailingPostCode|pt=Respondent|ifnull=ignore]]
Contact details: Daytime telephone [[Phone1|pt=Respondent| Mobile [[Phone_Mobile|pt=Respondent|ifnull=ignore]]
ifnull=ignore]]
Email [[E_Mail|pt=Respondent|ifnull=ignore]]
4. ORDER DETAILS
A. WHAT ORDERS DO YOU WANT?

Write down the section/s of the Boarding Houses Act 2012 and the orders you want the Tribunal to make. Refer to the
attached information for the sections of the Act and types of orders that can be made.
B. REASONS FOR ASKING FOR THE ORDERS?

You must explain why you are lodging this application and asking for Tribunal orders by providing as much
information as possible.
5. HEARING
A. UNAVAILABLE DATES
Indicate dates you are unable to attend hearing in the next 6 weeks:
B. SPECIAL NEEDS
Indicate whether you have any special needs such as a hearing loop or wheelchair access:
C. INTERPRETER
Do you need an interpreter for the hearing? Yes No
If yes, specify language and dialect:
6. APPLICATION CHECKLIST
I have attached all other documents relevant to this application
Attach details of multiple applicants or respondents, or further information about the orders you are seeking.
Note: A copy of this application and any attachments will be sent to the respondent.
I have made a copy of this application for my own records
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Before lodging your application with NCAT you must make a copy of your application for your own records.
I have attached the application fee
Refer to the fee schedule on the NCAT website. Credit card payments can be made by submitting a credit card authority
form with your application. Credit card surcharges apply. Cheque or money order payments are to be made out to ‘NSW
Civil and Administrative Tribunal’ or ‘NCAT’. Payment can be made in person at any NCAT Registry or NSW Service
Centre. Concession fee applicants must provide a photocopy of their concession card.
If you are unable to pay the concession fee or are not eligible, NCAT may consider waiving the fee fully or partially. To
request a fee waiver please complete the fee waiver request form.
7. SIGNATURE
Applicant’s signature or signature of representative.
Name:
Date:
Signature: [[system_date|fm=%-e/%m/%Y]]
Lodge your request at your nearest NCAT Registry

For NCAT Registry locations visit the NCAT website. For all NCAT enquiries telephone 1300 006 228 or visit
www.ncat.nsw.gov.au.
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March 2017

Occupancy fees or charges Access to goods Termination

B. ADDRESS OF BOARDING HOUSE

C. BOARDING HOUSE TYPE

D. RELATED FILE NUMBERS

Postal address: [[MailingAddressLine|pt=Applicant|ifnull=ignore]] [[MailingCity|pt=Applicant|ifnull=ignore]]

Contact details: Daytime telephone Mobile [[Phone1|pt=Applicant|fm=d|ifnull=ignore]]

Do you want NCAT notices and correspondence emailed to you?

Postal address: [[MailingAddressLine|pt=Respondent|ifnull=ignore]] [[MailingCity|pt=Respondent|ifnull=ignore]]

Contact details: Daytime telephone [[Phone1|pt=Respondent| Mobile [[Phone_Mobile|pt=Respondent|ifnull=ignore]]

A. WHAT ORDERS DO YOU WANT?

B. REASONS FOR ASKING FOR THE ORDERS?

Lodge your request at your nearest NCAT Registry

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