Application to Nominate an Adjudicator

APPLICATION
TO NOMINATE AN ADJUDICATOR

UNDER SECTION 33 AND SECTION 63
OF THE CONSTRUCTION CONTRACTS ACT 2002

The claimant hereby requests Building Disputes Tribunal (NZ) Limited (the Tribunal) to nominate an Adjudicator for the purpose of an adjudication under the Act and to manage and administer the procedures in relation to that adjudication.

***Please ensure that you read the guide to completing this application carefully. Please ensure that you complete all sections of this application form and that all details provided are correct***

1. Claimant’s Details

Name of Claimant:
Contact Person/Representative:
Address for Service of Notices and documents in relation to Adjudicator Appointment:

Post Code:		Phone:
Fax:		Mobile:
Email:

2. Respondent’s Details

Name of Respondent:
Contact Person/Representative:
Address for Service of Notices and documents in relation to Adjudicator Appointment:

Post Code:		Phone:
Fax:		Mobile:
Email:

Add another Party

3. Third Party’s Details

Third Party Type
Name:
Contact Person/Representative:
Address for Service of Notices and documents in relation to Adjudicator Appointment:

Post Code:		Phone:
Fax:		Mobile:
Email:

Add another Party

3a. Fourth Party’s Details

Fourth Party Type
Name:
Contact Person/Representative:
Address for Service of Notices and documents in relation to Adjudicator Appointment:

Post Code:		Phone:
Fax:		Mobile:
Email:

4. Applicants Details (Please complete only if different from Claimant’s details)

First Name:
Last Name:
Position/role of applicant::
Address of Applicant:

Post Code:		Phone:
Fax:		Mobile:
Email:

5. Notice of Adjudication

Please use the calendar provided to record the date that the Notice of Adjudication was served on the other party or parties to the construction contract and where appropriate, for the purpose of this adjudication, on the owner of the construction site
A copy of the Notice of Adjudication that was served on the other party or parties to the construction contract and where appropriate, for the purpose of this adjudication, on the owner of the construction site	If attached, please select file

6. Approval for the Issue of a Charging Order

Does the claimant seek the adjudicator's approval under section 29 of the Act for the issue of a charging order in respect of a construction site owned by the respondent?

Yes No

Does the claimant seek a determination under section 30(a) of the Act of the owner's liability to make payment to the claimant and approval under section 30(b) of the Act for the issue of a charging order in respect of the construction site owned by that owner?

Yes No

7. State Preferred Expertise

7.1 Please state the preferred expertise / knowledge / professional background (if any) of the person to be appointed as Adjudicator:

7.2 Are the parties in agreement as to the preferred expertise?

Yes No

7.3 A copy of the document recording the parties' agreement as to the Adjudicator's expertise:

If attached please select file

8. Panel of Adjudicators

Please advise whether the parties have reached agreement as to any person (or persons) on our Panel of Adjudicators whom they wish to request the Tribunal to nominate to act as Adjudicator in this matter. (Please note that the Tribunal will have regard to any such agreement but will not be bound by it, and any nomination will be at the sole discretion of the Registrar)

8.1 Have the parties reached agreement as to whom they wish to act as Adjudicator in this matter?

Yes No

8.2 Please name the person (or persons) chosen by agreement to act as Adjudicator in this matter:

8.3 A copy of the document recording the parties' agreement as to the Adjudicator:

If attached please select file

9. Inspection of Construction Work

Please advise whether the claimant is likely to request the Adjudicator to carry out an inspection of any construction work or any other thing to which the dispute relates (Please note that any inspection will be carried out at the sole discretion of the Adjudicator)

Yes No

10. Information in Electronic Format

Does the claimant consent to information being given in electronic form i.e. by email? (Refer Construction Contracts Regulations 2003 clauses 9 & 10)

Yes No

11. Security Amount

Payment may be made by direct credit, cheque or credit card on the next page.
Note: If you are unsure as to whether your claim is classed as a LOW VALUE CLAIM or a GENERAL CLAIM please refer to our Guide

*Is your claim a Low Value Claim or a General Claim?

Amount of claim (inclusive of GST) (ie. Enter 98643.00 if the amount of your claim is $98,643.00)

Amount in Dispute: NZ$

Security Amount: NZ$

Calculate Security Amount

12. Agreement

I confirm that the information I have supplied is true and correct to the best of my knowledge and that I have read and accepted the terms and conditions of the Building Disputes Tribunal

Please print a copy of your application for your records

APPLICATION TO NOMINATE AN ADJUDICATOR

APPLICATION
TO NOMINATE AN ADJUDICATOR