Document ID: chunk:federal_register_of_legislation:F2025C00017:schedule:1:p4
Version: federal_register_of_legislation:F2025C00017
Segment Type: schedule
Provision Reference: sch 1 (pt 4/7)
Character Range: 164608–167660

person who applied for the declaration recommendation.
3. Brief description of the service:
4. Facts and contentions on which I intend to rely:
5. Issues as I see them:
6. Address for service of documents:
(An address for service must comply with regulation 21 of the Competition and Consumer Regulations 2010—an address in Australia must be provided and, in addition, an electronic address may be provided).

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.

DIRECTIONS

   1. If an address is to be provided in this form, an electronic address may be provided in addition to the address required.

Form JAA Application for review by Australian Competition Tribunal
(subregulation 20(4))

Commonwealth of Australia

Competition and Consumer Act 2010

Application for review by Australian Competition Tribunal
(Title of matter)

PLEASE FOLLOW DIRECTIONS ON BACK OF THIS FORM

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 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—an address in Australia must be provided and, in addition, an electronic address may be provided).

   Dated .

                      Signed by or on behalf of the applicant

(signature)

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

DIRECTIONS

   1. If an address is to be provided in this form, an electronic address may