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***

Date contract entered into:
Date notice of adjudication served:
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
If the contract was entered into on or after 1 December 2015, you must wait until the 2nd working day after the notice of adjudication was served on the respondent before making this application. Please note the application must also be made before the end of the 5th working day after service of the notice of adjudication on the respondent.
2. Claimant’s Details
3. Respondent’s Details
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4. Third Party’s Details
Add another Party
4a. Fourth Party’s Details
5. Applicants Details (Please complete only if different from Claimant’s details)
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
Yes No

If attached please select file
8. Panel of Adjudicators
Yes No

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

Note: If you are unsure as to whether your claim is classed as a LOW VALUE CLAIM or a GENERAL CLAIM please CLICK HERE
Amount in Dispute: NZ$ 
Security Amount: NZ$ 
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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