FORM I
(subregulation 20(1))
APPLICATION TO TRIBUNAL FOR REVIEW
(Title)

1.	I (here insert name and address of applicant – where the applicant is a corporation, the corporation’s name should be inserted here, not the name of an officer of the corporation) hereby apply to the Australian Competition Tribunal pursuant to section 101 of the Competition and Consumer Act 2010 for review of the determination of the Australian Competition and Consumer Commission dated the 		
	day of    			20	          (Commission file no.                                     ).

2.	(a)	I was/was not (here delete whichever is not applicable) the applicant for the 
		authorisation to which the determination relates.
(b)	(To be completed if applicant for review was not applicant for authorisation).  
	My interest in the determination is as follows:

(Here set out particulars of the matters by reason of which the applicant will seek to satisfy the Tribunal that, for the purposes of subsection 101(1) of the Act, he has sufficient interest in the determination.)

3.	I am dissatisfied with the determination of the Commission in the following respects:

4.	The determination that I am seeking from the Tribunal is as follows:

5.	Particulars of the facts and contentions upon which I intend to rely in support of the application for review, and a statement of the issues as I see them, are attached.

6.	My address for service for the purpose of regulation 21 of the Competition and Consumer Regulations 2010 is (here insert address in Australia at which documents may be served for the purpose of the proceedings).

Dated this						day of 				20	.

Signed by/on behalf of the applicant

……………………………………..
(Signature)

……………………………………..
(Full Name)

……………………………………..
(Where applicant is a corporation, state position occupied in corporation by person signing.  If signed by solicitor for applicant this fact should be stated.)

History
Form I amended by SR No 330 of 1995, reg 10.1 and 10.2,
effective 6 November 1995; SR No 20 of 1996, reg 10.2,
effective 31 January 1996; SR No 280 of 2010, Sch 1, 
effective 1 January 2011 (as amended by SR No 337 of 2010).