Claim for Compensation from the Victorian Property Fund

Document Sample
Claim for Compensation from the Victorian Property Fund Powered By Docstoc
					Claim for Compensation from the Victorian Property Fund 
Estate Agents Act 1980, Section 81, Regulation 52 


Details of claimant(s)             (Attach a separate page if required with all claimants’ names and addresses.)
Name:                                                                 Address:

                                                                                                                                               Postcode


                                                                                                                                               Postcode


                                                                                                                                               Postcode



Details of estate agent you are making this claim against
Name of individual estate agent or employee of estate agent:                                       Name of estate agency:



Address of estate agency:

                                                                                                                                               Postcode



Details of claim
How much money are you claiming from the Fund?                   How much money was actually lost?              How much money have you recovered?

 $                                                                $                                               $

Describe the events that have led you to make this claim. (Provide details of who you spoke to, and when and how you chose this agency to manage
your property.) (Attach a separate sheet if you require more space.)




Privacy
Consumer Affairs Victoria is committed to responsible and fair handling of your personal information, consistent with the laws we administer
and the Information Privacy Act 2000. We may refuse or be unable to process this form if you do not provide the required information. You
can contact us at any time to request access to the personal information we hold about you. Our privacy statement, and other privacy
information, is available at www.consumer.vic.gov.au or on request.
What action have you taken to recover your loss? (Provide details of who you contacted and on what dates, what advice they gave you and when.)
(Attach a separate sheet if you require more space.)




Supporting documentation
Do you have any documentation to support your claim? (You need to attach receipts, rental authority rental agreements / leases, accounts, contracts,
invoices, records and/or banking documents showing monies owing, records and/or banking documents showing payments of rent, etc.)

NO              YES               Attach photocopies of all documents to this claim form



Certification and signature(s) of claimant(s)
I certify that:
• That the information given in this claim and any attachments is true and correct.
• I acknowledge and understand it is an offence under section 93 of the Estate Agents Act 1980 to furnish any particulars which are not correct or omit
    any particulars (penalty $10,000).

Signature(s) of claimant(s)                                                 Date                                        Daytime telephone number

                                                                                         /            /


                                                                                         /            /


                                                                                         /            /


How to lodge this claim
Post to: Compliance and Enforcement, Consumer Affairs Victoria, GPO Box 123, Melbourne Victoria 3001.




Privacy
Consumer Affairs Victoria is committed to responsible and fair handling of your personal information, consistent with the laws we administer
and the Information Privacy Act 2000. We may refuse or be unable to process this form if you do not provide the required information. You
can contact us at any time to request access to the personal information we hold about you. Our privacy statement, and other privacy
information, is available at www.consumer.vic.gov.au or on request.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:2
posted:3/27/2010
language:English
pages:2
Description: Claim for Compensation from the Victorian Property Fund