Detail

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Schedule 3

FORM 1

(Regulation 4)

COMPLAINT FORM

Please insert your details:

1. Mr. [] Mrs. [] Miss [] Ms [] Other ...............................................................

2. First Names ............................................................................................

3. Surname ..............................................................................................................

4. Address .................................................................................................

..............................................................................................................

5. Postal Address (if different from above)

................................................................................................................

6. Address for service of documents (if different from above) .............................

7. Daytime telephone contact number(s) .........................................................

8. Fax number(s) ..........................................................................................

9. Email address ..........................................................................................

10. If an Attorney or Legal Counsel is acting for you please give details (all documents will be sent to your representative)

Name .....................................................................................................

Address ..............................................................................................................

...............................................................................................................

Postal address (if different from above) ........................................................

Address for service (if different from above) .................................................

Daytime telephone number (s) ....................................................................

Email address ...........................................................................................

11. Please give the name and address of the Telecommunications Provider against whom this complaint is being brought Name ..............................................

Address ..............................................................................................................

...............................................................................................................

Postal address (if different from above) .......................................................

Address for service (if different from above) ................................................

Daytime telephone number(s) ....................................................................

Fax number(s) .........................................................................................

Email address ..........................................................................................

12. Please give details/grounds of your complaint ..............................................

...............................................................................................................

..............................................................................................................

...............................................................................................................

(Please use additional paper if necessary)

......................................

Signature

FORM 2

(Regulation 6)

APPLICATION TO COMMISSION

Pre-fix ................................................ Complaint number ................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names .............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] .........................................................

2. First Names ...............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Application is hereby made to the Commission pursuant to regulation 6 of the Telecommunications (Dispute Resolution) Regulations to assist the parties in the resolution of a dispute.

Attached to this application are the following documents: -

1. Statement of Complaint

2. (any other relevant documents)

Having regard to the nature of the complaint I hereby request that this matter be determined by… [Please tick appropriate box]

[ ] Commission to review documents and make a decision

[ ] Mediation

[ ] Tribunal

[ ] Arbitration

[ ] No preferred option

Dated this ............................. day of ........................., ................................ .

Applicant/Applicant's representative

FORM 3

(Regulation 10)

NOTICE OF DISCONTINUANCE

Pre-fix ......................................... Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ...............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] ........................................................

2. First Names .............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ...............................................................

Take Notice that the parties to this dispute hereby discontinue [state here the ADR process which was utilised for resolution of the dispute] pursuant to regulation 10 of the Telecommunications (Dispute Resolution) Regulations.

Dated this .............................. day of .............................., .............................. .

................................................. ...............................................

Applicant Respondent

FORM 4

NOTICE OF APPEARANCE

Pre-fix ................................................ Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] ........................................................

2. First Names .............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] .......................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of document ................................................................

WARNING: If this form is not fully completed and returned to the Commission at the address below within 10 days of service of the complaint form on you, the claimant will be entitled to have the tribunal adjudicate on this matter in your absence. If the claimant does so, you will have no right to be heard by the Commission except as to matters set out in paragraph 8(3) of Part 3 of Schedule 2

1. Have you received the complaint form with the above claim number?

YES/NO

2. If so, when? ___/___/___

3. Are your names properly stated on the complaint form?

If not, what are your full names? …………………………… YES/NO

4. Is your contact information on the complaint form correct?

If no please proceed to number 5 YES/NO

5. Insert here correct contact information for you

6. Do you intend to defend the complaint? If so give the particulars and grounds on which you intend to resist the application(use extra sheet if required) YES/NO

7. Will you be represented by Legal Counsel, Attorney or self

(please circle your choice of representation)

8. If an Attorney or Legal Counsel is acting for you please give details (all documents will be sent to your representative)

Name ......................................................................................................

Address ....................................................................................................

Postal address (if different from above) ........................................................

Address for service (if different from above) .................................................

Daytime telephone number (s) ...................................................................

Fax number(s) ..........................................................................................

Email address ..........................................................................................

Dated ................................................

Signed ..............................................

[respondent in person] respondent's legal practitioner/Attorney]

The Commission's office is at [*** *** ***] telephone number *** ****, FAX *** ****. The office is open between [… a.m.] and [… p.m.] ……….. to ……………. except public holidays.

FORM 5

(Regulation 25)

DISPUTE RESOLUTION ORDER

Pre-fix ............................................... Complaint number ................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] .......................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ...............................................................

..............................................................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] ..........................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of document ..................................................................

Upon hearing the parties or their representatives/reading the [insert here the documents referred to]/upon hearing the parties or representatives and reading [insert documents being referred] to the Tribunal hereby orders:
1. 1 .....….
1. 2 .....….
1. 3 .....….

Dated this .......................... day of ................................, ............................... .

...............................................

Chairman

FORM 6

NOTICE OF HEARING

Pre-fix ............................................... Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] .........................................................

2. First Names ..............................................................................................

3. Surname ...................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] other [ ] ..........................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Take notice that the above captioned matter shall be heard the [Mediator, Tribunal, Arbitration panel on ...................... day the ...................... day of ...................... 200[ ] at ...................... O'clock in the fore/after noon.

Dated the ...................... day of ......................................, ...................... .

...........................................

Mediator/Chairman

FORM 7

NOTICE OF APPLICATION FOR AN EXTENSION OF TIME

Pre-fix ............................................... Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ]Other [ ] .......................................................

2. First Names ..............................................................................................

3. Surname ...................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Take notice that the Applicant/Respondent in the above captioned matter has applied to [Mediator, Tribunal, Arbitration panel] for an extension of time to [state here the purpose or the reason for the application] and that the application will be heard on ................... day the ................... day of ................... 200[ ] at ................... o'clock in the fore/after noon.

Dated the ................... day of ......................................, ................... .

...............................................

Mediator/Chairman

FORM 8

NOTICE OF PRE-HEARING

Pre-fix ................................................ Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ..............................................................................................

3. Surname .................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents .................................................................

Take notice that the tribunal in the above captioned matter has received an application from the Applicant/Respondent for a pre-hearing on [where applicable attach any written submissions for the review of the respondent to the application for the pre-hearing or state which part of the complaint or notice of appearance is being referred to].

Should you wish to make representation on this issue before the tribunal you may:

1. file written submission within 10 days of service of this notice on you or

2. attend before the tribunal on the date stated below where you will be heard

Take further notice that the matter shall be heard by the Tribunal on ....................... day the ................... day of ................... 200[ ] at ................... o'clock in the fore/after noon.

Dated the ................... day of ........................................, ....................

.................................................

Mediator/Chairman

FORM 9

NOTICE OF DETERMINATION

Pre-fix ................................................ Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] .......................................................

2. First Names ..............................................................................................

3. Surname ..................................................................................................

4. Address for service of documents ................................................................

Take notice that the tribunal in the above captioned matter has considered the application by the Applicant/Respondent for a pre-hearing of [state here the nature of the application] and has denied the application on the following ground(s)

1. …

2. …

3. …

Dated the ................... day of ........................................, ................... .

..............................................

Chairman

FORM 10

WITNESS SUMMONS

Pre-fix ................................................ Complaint number ................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ........................................................

2. First Names ............................................................................................

3. Surname ...............................................................................................

4. Address for service of documents ..............................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ......................................................

2. First Names ............................................................................................

3. Surname ................................................................................................

4. Address for service of documents ...............................................................

Pursuant to section [ ] of the Telecommunications Act No [ ] of 200[ ] you are hereby summoned to attend a sitting of the Tribunal in the above captioned matter at [insert here venue] on ................... day the ................... day of ................... 200[ ] to give evidence and to bring with you the following documents:

1. …..

2. ….

3. …. ( or indicate not applicable/NA)

Dated the ................... day of ........................................., ................... .

.........................................

Chairman

FORM 11

ORDER

(all other orders made by tribunal)

Pre-fix ................................................ Complaint number .................................

[to be completed by the Commission] [the complaint number provided by the Telecommunications Provider]

Particulars of Applicant:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] .......................................................

2. First Names .............................................................................................

3. Surname ..................................................................................................

4. Address (for service of documents) .............................................................

Particulars of Respondent:

1. Mr. [ ] Mrs. [ ] Miss [ ] Ms [ ] Other [ ] ......................................................

2. First Names .............................................................................................

3. Surname ..................................................................................................

4. Address (for service of documents) .............................................................

Upon hearing the parties or their representatives OR reading the [insert here the documents referred to] OR upon hearing the parties or representatives and reading [insert documents being referred to] on an application for [insert here what the nature of the application was] the Tribunal hereby orders: