Office use only Filed Application no. Time Building and Construction Industry Payments Act (Qld) 2004 Adjudication application by claimant Tax Invoice Lodgement of this form and supporting documentation constitutes an application for adjudication of a payment claim by the claimant under the Building and Construction Industry Payments Act (Qld) 2004 Privacy Collection Notice: Queensland Law Society, as an ( ANA ), is collecting your personal information to assist you in applying for adjudication of payment disputes in the construction industry within Queensland pursuant to the Building and Construction Industry Payments Act 2004 ( BCIP Act ). The information you provide on this form is forwarded to an adjudicator, who will make a legally binding decision as to whether any money is payable to the claimant, and the conditions, if any, attached to the payment amount. Such information may also pass to the courts if the outcome of the claim is further disputed or needs to be enforced. In addition, your personal information is entered into an external database owned and maintained by the Building and Construction Industry Payments Agency ( BCIPA ) as required under the BCIP Act. Decisions made by the adjudicator are published on the BCIPA website and include party names and relevant particulars that outline the matter. Business details you choose to provide on this application may be transferred and stored overseas to administer such services and communications to you. By completing this application, you agree to this transfer and Australian Privacy Principle 8.1 will not apply to this disclosure. In accordance with the Electronic Transactions (Queensland) Act 2001, the Society may provide notices or correspondence to you by electronic communication. By completing this application, your consent to this form of contact is taken to be given. Further details about the Society s Privacy ment, Plan and Code of Practice and the collection of personal information may be found on the Society s website qls.com.au To fill out this form: (a) complete the fields on screen; (b) print the form; (c) sign the form; (d) send original and one copy to Queensland Law Society, and serve one copy on on respondant. Queensland Law Society Inc. 179 Ann Street GPO Box 1785 Brisbane Qld 4000 Fax: 07 3221 9329 Email: dmc@qls.com.au ABN 33 423 389 441 Claimant s details Name of person or company Trading name (if different) If company, name of contact person Residential or business address Phone Fax Email ABN/ACN QBCC Licence No. or alternative trade licence no. Claimant role e.g. supplier, subcontractor, designer, engineer Type of business e.g. engineering, building, landscaping, electrician Building and Construction Industry Payments Act (Qld) 2004 adjudication application by claimant page 1 of 5
Respondent s details Name of person or company Trading name (if different) If company, name of contact person Residential or business address Phone Fax Email ABN/ACN QBCC Licence No. or alternative trade licence no. Respondent role e.g. principal, head contractor, developer Owner/Builder Permit No. Type of business e.g. builder, supplier, developer Reason for Application (select one) Application made under: s 21(1) (a) (i) s 21 (1) (a) (ii) s 21 (1) (b) Respondent s payment schedule is less than the payment claim Respondent failed to pay the scheduled amount by due date or Respondent did not serve a payment schedule and did not pay the claimed amount Contract details (Note s required refer to payment claim documentation NOT invoice documentation) Project name Address of project Contract number Reference date* payment claim served on the Respondent payment schedule served on claimant (if appropriate) Payment claim number Payment claim due date (NOT due date of invoice) Claim amount Schedule amount * Reference date is the date on which a claim for a progress payment may be made as stated in the contract or if no date is provided, the last day of each calendar month which cannot be more than 12 months from the date the work was completed. Building and Construction Industry Payments Act (Qld) 2004 adjudication application by claimant page 2 of 5
Documentation This claim relates to the following: Document Description Attachment/page no. Adjudication application Payment claim Including written confirmation of service upon the respondent S 21 (1)(b) Notice (if appropriate) Including written confirmation of service upon the respondent Received on Received on Payment schedule Including written confirmation of service upon the claimant Received Yes No Served on Claimant submissions Written summary of information for the adjudicator showing that the claimant has carried out the work or supplied the goods, how the work/goods were valued, arguments against the respondent s reasons for withholding payment and explaining why the claimant believes they are entitled to payment Construction contract See item 2 in checklist (copies of written, detail of oral) Other supporting documents May include, but not limited to: invoices, variations, rectification orders, emails, faxes, general correspondence, job diary notes ANA Adjudication application fee for claims above $50,000 $242 Tax Invoice: This application form will be a tax invoice for GST purposes when you make payment. Please retain a copy for your tax records. Signed (claimant) Signatory position description Building and Construction Industry Payments Act (Qld) 2004 adjudication application by claimant page 3 of 5
Claimant checklist In accepting this application the QLS ANA acts only as an independent referral authority. Referral of this application to an adjudicator is not to be taken as verification that the applicant has complied with the BCIP Act. Applicants should take care to comply with the procedural requirements of the BCIP Act such as acting within set time limits, correct service of documents and proof of service of documents. Applications may fail on technical grounds if procedural requirements are not met. The checklist and form is provided for your assistance only and does not constitute legal advice. This form and checklist should be completed with reference to the BCIP Act. Information about the BCIP Act is also available on the QLS website. To fill out this form: (a) complete the fields on screen; (b) print the form; (c) sign the form; (d) send copies to the respondent and Queensland Law Society. Please indicate where applicable 1. Pre-conditions to claim Prior to issuing a payment claim, the following conditions must be met the claim relates to construction work or the supply of related goods and services work was not carried out for a resident owner work was carried out in Queensland, AND Timeframe to issue a payment claim is still within 12 months from the date the last work was completed OR within the period worked out under the construction contract (choose one) 2. The construction contract (attach copy if any) is written and a copy is attached OR is an oral contract, and all relevant details are attached OR is partly written and partly oral, a copy of the written part and all relevant details of the oral part are attached 3. The payment claim (attach copy) must be served within 12 months after the construction work was last carried out or related goods and services were last supplied, OR within the period worked out under the construction contract (choose one), AND identify the relevant construction work or related goods and services state the amount claimed be in writing and served on the respondent who is the person under the contract who is liable to make the payment state that This is a payment claim made under the Building and Construction Industry Payments Act 2004 Building and Construction Industry Payments Act (Qld) 2004 adjudication application by claimant page 4 of 5
4. The payment schedule (attach copy if any) was served within the earlier of the time required by the construction contract OR within 10 business days after service of the payment claim OR was not served within the earlier of the time in the construction contract or within 10 business days after service of the payment claim OR no schedule was served and notice of intention to refer to adjudication was given within 20 business days after due date for payment 5. Claimant s submissions (attach copy) are contained in this application and attached 6. Time limitations This application is made within one of the following timeframes Option 1: Payment schedule is less than payment claim Within 10 business days after the claimant receives the payment schedule OR Option 2: Respondent fails to pay scheduled amount by due date Within 20 business days after the due date for payment OR Option 3: Respondent fails to serve payment schedule and fails to pay claimed amount (s21(1)(b) Notice) Notice has been given to the respondent within 20 business days, immediately following the due date for payment, of intention to apply for adjudication of the payment claim (attach copy) AND The notice stated that the respondent may serve a payment schedule on the claimant within 5 business days after receiving the claimant s notice AND This application is within 10 business days after the end of the 5 business day period. 7. Service of documents The applicant must satisfy the adjudicator of the service of all documents required to be served including the payment claim, this application and if appropriate, the s21(1)(b) Notice. 8. Application fee For claims above $50,000, an application fee of $242 (inclusive of GST) to be paid at the time of making the application, by way of cheque payable to Queensland Law Society, is attached. 9. Service of this application The original of this application and all supporting documents and attachments should be copied three times: 1 original and 1 copy to the Queensland Law Society 1 copy for service on the respondent 1 copy for your records A copy of the application and all supporting documents and attachments has been served on the respondent at by (address) (method e.g. delivery, post) on day of * * this is for Queensland Law Society records only and is not proof of service Signed (respondent) Signatory position description Building and Construction Industry Payments Act (Qld) 2004 adjudication application by claimant page 5 of 5