FORM JAA
(subregulation 20(4))
APPLICATION FOR REVIEW BY AUSTRALIAN COMPETITION TRIBUNAL
Commonwealth of Australia
Competition and Consumer Act 2010
(Title of matter)

Name of applicant:	(insert full name of applicant)
Address of applicant:	(insert address of applicant)
(If the applicant is a corporation, the corporation’s name and address should be inserted here, not the name and address of an officer of the corporation).

1.	Application is made to the Australian Competition Tribunal under section 151CI of the Competition and Consumer Act 2010 for review of a decision of the Australian Competition and Consumer Commission under section 151BA of that Act to refuse to make an exemption order relating to conduct of the applicant, being the decision, order and conduct described below.

2.	The decision of the Commission is dated (insert date of decision) and the number of the Commission file for the matter is (insert file no.).
 
3.	The Commission refused to make an exemption order having the following effect:
(state the effect briefly).

4.	The conduct was as follows:
(state the conduct briefly).

5.	The following features of the Commission decision are unsatisfactory:
(state the features briefly).

6.	The facts and contentions on which this application relies are as follows:
(state the facts and contentions briefly).

7.	Address for service of documents:
(insert address for service)
(An address for service must comply with regulation 21 of the Competition and Consumer Regulations 2010).

Dated

Signed by or on behalf of the applicant
(Signature)
(Full Name)

……………………………………..
(If the applicant is a corporation, state position occupied by the signatory in the corporation.  If the signatory is a solicitor for applicant, state that fact.)

History
Form JAA inserted by SR No 322 of 1997, reg 10.1, effective
27 November 1997; amended by SR No 280 of 2010, Sch 1, 
effective 1 January 2011 (as amended by SR No 337 of 2010).