Application Form - Motor Vehicle Disputes Tribunal
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1
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3Motor Vehicle Disputes Tribunal
For more information visit
MVDT No:
(MDVT use only)
Application Form
What is this form for?
This form is an application for proceedings before a Motor Vehicle Disputes Tribunal under
clause 4 of Schedule 1 of the Motor Vehicle Sales Act 2003.
Important Information
1. Please ensure you complete this ‘Application Form’ using the ‘Guide to Filing a Claim’.
This will ensure your form is completed correctly and will not have to be returned to you.
2. Please submit this form by post to the Secretary, Motor Vehicle Disputes Tribunal,
DX EX 11086, Auckland.
Z
Part 1: Applicant(s)
(Purchaser: the purchaser is the name on the purchase agreement)
Applicant/Purchaser/(s)
Surname(s):
First name(s):
or, company name:
Physical address
Address for service (if different from physical address)
Street:
Street:
Suburb:
Suburb:
City / town:
City / town:
Post code:
Post code:
Contact details
Daytime contact phone number: (
)
Mobile:
Fax number: (
)
Email address:
Z
Part 2: Respondent
(Trader: if a registered company please search for the respondent details at )
Motor vehicle trader name:
Trader registration number (required): M
(note: this number is found on the window card)
Address for service
Contact details
Street:
Daytime contact phone number: (
)
Suburb:
Mobile:
City / town:
Email address:
Post code:
Fax number: (
)
Town or city where the transaction took place:
Note: In the case of an Internet sale, the location of the sale is likely to be the sellers listed location.
Page 1
For more information visit
MVDT 03/14 - 1
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