FORM JC
(subregulation 20A(3))
APPLICATION TO TRIBUNAL FOR REVIEW
(Title)
Name of applicant:
Address of applicant:
(If the applicant is a corporation, give the corporation’s name and address, not the name and address of an officer of the corporation).
1.	I apply to the Australian Competition Tribunal under subsection 44ZX(1) of the Competition and Consumer Act 2010 for a review of the decision of the Australian Competition and Consumer Commission not to register a contract dated (date) between (names of parties), relating to the service described below.
2.	Brief description of the service:
3.	Facts and contention on which I intend to rely:
4.	Issues as I see them:
5.	Address for service of documents:
(An address for service must comply with regulation 21 of the Competition and Consumer Regulations 2010).

Dated:					20		Signed by/on behalf of the applicant:
(Signature)
(Full name)
………….………………………………
(If applicant is a corporation, state position occupied in corporation by person signing.  If signed by a solicitor for applicant this fact should be stated).
* Delete if not applicable
History
Form JC inserted by SR No 20 of 1996, reg 10.4, effective 31 January 1996;
amended by SR No 280 of 2010, Sch 1, effective 1 January 2011 (as amended by SR No 337 of 2010).