Rialto Adjudications Pty Ltd

And To:	The Respondent

Claimant Details:

Name:
Contact:
ABN/ACN:
Ordinary Place of Business:
Phone Number:
Fax Number:

Respondent Details:

Name:
Contact:
ABN/ACN:
Ordinary Place of Business:
Phone Number:
Fax Number:

Project Details:

Address of Project:
Type of Project:
Contract Number (if applicable):
Date of Payment Claim:
Total amount of this Payment Claim:	$
Date of Payment Schedule:
Amount Respondent proposes to pay:	$

The Claimant applies for adjudication under the Building and Construction Industry Security of Payments Act 2002 (Vic).

Signed on behalf of the Claimant:
Date:

Application Checklist:

The following copy documents should be submitted with this Application for Adjudication:

• the Contract
• the Payment Claim (including any supporting documents submitted in support of the Payment Claim)
• the Payment Schedule (including any supporting documents served with the Payment Schedule)
• submissions of the Claimant

Information for the Respondent:

1. The Respondent may lodge with the adjudicator a response to the Claimant's adjudication application (the Adjudication Response) at any time within -
   1. 5 business days after receiving a copy of the application; or
   2. 2 business days after receiving notice of an adjudicator's acceptance of the application - whichever time expires later.
2. The Adjudication Response -
   1. must be in writing; and
   2. must identify the adjudication application to which it relates; and
   3. must include the name and address of any relevant principal of the Respondent; and
   4. may contain any submissions relevant to the response that the Respondent chooses to include.
3. A copy of the adjudication response must be served on the Claimant.