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Getting Started

Adjudication Application
Fields marked with * are required
Building and Construction Industry Payment Act 2004 (Qld)
This form is to be used for an application for adjudication of a payment claim made under the Building and Construction Industry Payment Act 2004 (Qld) hereafter referred to as ‘the Act’. Completing this form
Before you submit this form, carefully read the information provided on the Queensland Building and Construction Commission (QBCC) website. The fees are calculated automatically. The claimant hereby applies for adjudication under section 21 of the Building and Construction Industry Payments Act. The documents attached to or submitted with this application form part of this application. Please complete all details below, taking particular care to correctly identify the business details of the respondent and the contract in dispute. You are to serve a full copy of this application for adjudication on the respondent before the application can be decided by an adjudicator. The electronic submission of this application will only be considered when payment is made by a valid credit card. This application form may be saved at any stage while it is being completed, in order to return to it at a later date. This application form may be completed and printed for submission in hardcopy. The claimant acknowledges that they may be responsible for the payment of further fees in accordance with the Act.

Application type

Application - Payment Claim date *
Payment Claim amount *

The Claimant

Adjudication Application
Fields marked with * are required

Claimant contact details

What is the type of the claimant? *
At least one of the phone or mobile numbers is required *

Contact person

Postal address

Preferred method of receiving correspondence from the registry and the adjudicator?

Claimant details

Claimant type *

Agent contact details

What is the type of the agent? *
At least one of the phone or mobile numbers is required *

Contact person

Agent postal address

The Respondent

Adjudication Application
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Respondent contact details

What is the type of the respondent? *
At least one of the phone or mobile numbers is required *

Contact person

Postal address

Respondent's representative

Was there a representative acting on behalf of the Respondent? *

Respondent details

Respondent type *

Agent contact details

What is the type of the agent? *
At least one of the phone or mobile numbers is required *

Contact person

Agent postal address

Claim Details

Adjudication Application
Fields marked with * are required

Contract and project details

Project address

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Please be aware that a claim under the BCIPA (Qld) can only be made for construction work, or the supply of goods and services, carried out in Queensland. Please confirm the project address before proceeding.

Payment claim details

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The date cannot be prior to the date payment claim served or due date for payment.
Are you also claiming GST? *
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Your payment claim is for more than $750,000. Please return to the “Getting Started” tab and change your claim to a Complex Claim before proceeding.
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Your payment claim is for less than $750,000. Please return to the “Getting Started” tab and change your claim to a Standard Claim before proceeding.

Payment schedule detail

Payment Schedule served? *
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A payment schedule may not be served before a payment claim has been made. Please confirm the dates of service before proceeding.
Are you adding GST to the Payment Schedule amount above? *

Service of this application

Has a complete copy of the application been served on the respondent including all submissions and documents? *

Confirmation

Adjudication Application
Fields marked with * are required
PRIVACY NOTICE
By making this application for adjudication, you authorise the disclosure of the information in it to any registered adjudicator referred the application to decide it. The functions of the Registrar of the Adjudication Registry include: 1.the collection of statistical data and other information relevant to the administration of the Registry. Information you provide in this form may be collected for that purpose. 2.The keeping of records of decisions by adjudicators and the publication of the decisions in a way approved by the Commissioner of the QBCC. The Commissioner has approved the publication of adjudication decisions on the QBCC’s website. Information about the Commission’s Privacy Policy is available on its website.
COMPLIANCE WITH REQUIREMENTS
To obtain a full appreciation of your rights and obligations under the Act, it is recommended you obtain independent legal advice. In accepting this application, the Queensland Building and Construction Commission acts only as an independent referral authority. Referral of this application by the QBCC to an Adjudicator for decision is not to be taken as verification by the QBCC of compliance with the Act. Applicants should take care to comply with the procedural requirements of the Act such as acting within prescribed time limits, correct service of documents and proof of service of documents. Adjudication applications may fail on technical grounds if procedural requirements are not met. The Adjudication Application Checklist is provided for your assistance only and does not constitute legal advice. Both this form and the Checklist should be completed with reference to the Act. Information about the Act is also available on the QBCC website, www.qbcc.qld.gov.au.
INFORMATION IN WRITING
If required to give information in writing the QBCC, including the Adjudication Registry, may give the information by an electronic communication. By making this application for adjudication, you consent to the information being given by an electronic communication.

Fees

Upon submission of this form you will be asked to pay an application fee of the amount shown below. If payment fails the application will be rejected. Please keep a receipt of the transaction to confirm payment. For any issues regarding the payment process please contact the registry.
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Please confirm your preferred method of payment *
Paying online is safe and easy with out secure Credit/Debit Card facility. The following cards are accepted:
Contact your bank or financial institution with the details that will be presented on your receipt to make a BPAY payment using your savings or cheque account.

Supporting documentation

If you have supporting documents that you would like to include with your application please indicate below and you will be asked to upload these documents when you submit this form.
ELECTRONIC SERVICE OF APPLICATION:
The claimant hereby applies for adjudication under section 21 of the Building and Construction Industry Payment Act 2004 of the progress payment to be made in respect to the payment claim. In ticking this box and applying for adjudication the claimant agrees that: 1.The information provided in this application is true and correct to the best of their knowledge; 2.The application form and its attachments have been read, are understood and are agreed; 3.The claimant is required to serve a complete copy of the adjudication application (including all submission and attachments) to the respondent. The claimant must also provide evidence of service to the adjudicator. If the application is not served on the respondent on the same day the application is made, the applicant will immediately notify the adjudicator of the date of service upon the respondent and provide evidence of service. 4.Service must be affected in accordance with the Act. 5.The claimant will pay the application fee in full at time of lodgement. Failure to pay the application fee will result in a rejection of the application. 6.The claimant understands that the adjudication decision will be published in accordance with the Act. (Electronic submission of the adjudication application with the QBCC will be accepted as valid lodgement) (Electronic applications submitted after 5pm Queensland time will be taken to be lodged on the following business day in accordance with the Act.)

Agreement

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