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Application for Referral of a Dispute
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Application for Referral of a Dispute
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Getting Started

Application for Referral of a Dispute
Fields marked with * are required
Before completing this application form, please consider talking this matter over with your solicitor or contacting the Victorian Small Business Commission on 13 VSBC (13 8722).

Note: the details you provide in this Application, and any accompanying documents, may be forwarded to the Respondent. Submission of this Referral Form indicates your agreement to this.
Do you need to complete this form? Before completing this application consider talking this matter over with your Solicitor or contacting the Victorian Small Business Commission on 13 87 22.
Please select one of the following as best describes you:
To enable us to assist you better, please answer the following questions
Have you had any previous contact with this Office by phone or email in relation to this matter?
What is the size of your business?

Applicant Details

Application for Referral of a Dispute
Fields marked with * are required

Applicant details

(Name of person or company referring dispute)
If there is more than one applicant, provide the name and address of the second and subsequent applicants, and of their representatives, using the "Add Applicant" button below.'
Status of person or company referring dispute.

Tenancy details

Premises details

Status of person or company referring dispute Who is filling in this form? If there is more than one applicant, use the "Add applicant" button below.
Status of person or company referring dispute.

Applicant information

Applicant
Is the applicant an individual or a company?
Name of natural person contact for applicant
Name of natural person contact for applicant
At least one contact phone number is required *
Does the applicant have a representative?
Select Yes if the applicant is represented by an agent or solicitor.
RepresentativeIf details are entered contact and correspondence will be made through the representative (e.g. solicitor or estate agent)
Representative If details are entered contact and correspondence will be made through the representative
At least one contact phone number is required *

Respondent Details

Application for Referral of a Dispute
Fields marked with * are required

Respondent details

Respondent details of other party to dispute, being a person or company. If there is more than one respondent, use the "Add respondent" button below.

Respondent information

Status of respondent. Respondent details of other party to dispute, being a person or company. If there is more than one respondent, use the "Add respondent" button below.
Status of respondent. Respondent details of other party to dispute, being a person or company. If there is more than one respondent, use the "Add respondent" button below.
Status of respondent. Respondent details of other party to dispute, being a person or company. If there is more than one respondent, use the "Add respondent" button below.
Respondent
Is the respondent an individual or a company?
Name of natural person contact for respondent
Name of natural person contact for respondent
Does the respondent have a representative?
Select Yes if the respondent is represented by an agent or solicitor.
RepresentativeIf details are entered contact and correspondence will be made through the representative (e.g. solicitor or estate agent)
Representative If details are entered contact and correspondence will be made through the representative

Dispute Details

Application for Referral of a Dispute
Fields marked with * are required

Dispute details

of 4000 characters
of 4000 characters

Supporting documents

Optional provide additional documents on this matter (e.g. lease), please supply as: bmp; docx; gif; jpeg; jpg; xls; xlsx; doc; pdf; txt; tiff; zip.
Optional provide additional documents on this matter (e.g. lease), please supply as: bmp; docx; gif; jpeg; jpg; xls; xlsx; doc; pdf; txt; tiff; zip.
File:

Lodgement

Application for Referral of a Dispute
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Privacy statement

Consistent with Victorian Government policy, the office endorses fair information handling practices. The Victorian Small Business Commission does not collect or record personal information, except that which you provide freely via specific online forms. Any information provided will be treated as confidential and used only for the purpose intended or stated on the form unless in exceptional circumstances where authorised by law. Email addresses will only be used to respond to specific user queries and will not be kept or used for any purpose other than stated. Email addresses will not be added to a mailing list unless consent is given, nor disclosed to any other party without the users knowledge or consent.

Your feedback

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The Office of the Victorian Small Business Commission