This form is for use in the AAT’s General Division, Freedom of Information Division, National Disability Insurance Scheme Division, Security Division, Taxation & Commercial Division and Veterans’ Appeals Division
Subsection 41(3) of the Administrative Appeals Tribunal Act 1975 provides that, if an order is in force under subsection 41(2) of the AAT Act, a party to the proceeding may request an order varying or revoking an order staying or otherwise affecting the operation of implementation of the decision to which the proceeding relates.
The person described in section 1 is a party to the proceeding described in section 2 and requests an order varying or revoking the order referred to in section 3.
SECTION 1   APPLICANT MAKING THE REQUEST	
Name	Mr     Mrs     Ms      Miss     Other:  	
	Family name:	
	Given name(s):	
Organisation Name
If applicable	

Address		
		
		State:  	Postcode:	
Telephone	Landline: (         )	Mobile: 	
Fax 	(         )	
Email		
	
Representative 
If you have a representative, please fill in these details	Name:	
	Organisation:	
	Postal address:
	
		State: 	Postcode:	
	
Telephone	Landline:  (         )	Mobile:	
Fax 	(         )	
Email		
		
Turn to page 2 	

SECTION 2   PROCEEDING	
AAT File Number 

Names of the parties to the proceeding	

	
SECTION 3   DATE OF ORDER	
Date of the order about the decision 	dd   /    mm      /  yyyy	
	
SECTION 6   DATE OF PREVIOUS ORDER	
Date of any previous order about the decision	dd   /    mm      /  yyyy	
	
SECTION 7   GROUNDS 	
State the grounds for the request.	

	
SIGNATURE	
Signature	

	Date	dd   /    mm      /  yyyy	

WHAT DO WE DO WITH INFORMATION GIVEN TO US?
We collect information from you to process and consider your request under the Administrative Appeals Tribunal Act 1975. 
We give a copy of the form to the department or organisation that made the decision you want reviewed. We may also give a copy to any other person that is a party to the review. If you give us other information that another party does not have, we will usually give them a copy.
Limited information about cases in the AAT’s General Division, Freedom of Information Division, National Disability Insurance Scheme Division, Taxation & Commercial Division or Veterans’ Appeals Division is usually made available to the public on request and can be accessed using eCase Search on our website. This information includes the names of the parties and any representatives, the type of application, dates of conferences, hearings or other case events, the types of key documents lodged by the parties and the outcome of an application.
More information is usually made publicly available if we hold a hearing and make a decision. If we prepare a written statement of the reasons for our decision in your case, it will usually be made public and published on the internet, including on the AustLII website (www.austlii.edu.au). For more information about the decisions we publish, see our Publication of Decisions Policy on our website.  
We can order that information be kept confidential if we believe there is good reason to do so. You can apply for an order by writing to us stating what information you want kept confidential and why. In some cases, legislation requires that information be kept confidential. 
For more information see our fact sheet, Privacy and confidentiality at the AAT, and our Privacy Policy. Our Privacy Policy includes information about how you can access and seek correction of your personal information, make a complaint about the way we have handled your personal information and how we will deal with such a complaint. Privacy and confidentiality at the AAT and our Privacy Policy are on our website or are available from your local AAT registry.
MORE INFORMATION ABOUT THE AAT
For more information about the AAT and how we conduct reviews, go to our website or call us. Our staff can give you information about procedures but cannot give you legal advice.
HOW DO I SUBMIT THIS FORM?	
You can send us your form by email, post or fax, or deliver it to a registry.		
Email:	generalreviews@aat.gov.au		
Post:	AAT, GPO Box 9955, Your capital city (Northern Territory residents should write to Adelaide)
or   
AAT, c/- Supreme Court of Norfolk Island Registry, Kingston, Norfolk Island 2899	
In person or by fax:		
Adelaide 
Level 2
1 King William St
ADELAIDE SA 5000	Brisbane
Level 6
295 Ann St
BRISBANE QLD 4000	Canberra
Level 8
14 Moore St
CANBERRA CITY ACT 2600	Hobart
Edward Braddon Building
Commonwealth Law Courts
39–41 Davey St
HOBART TAS 7000	
Fax (08) 8128 8099	Fax (07) 3052 3001	Fax (02) 6243 4600	Fax (02) 9276 5597	
Melbourne
Level 4
15 William St
MELBOURNE VIC 3000	NORFOLK ISLAND
Supreme Court of Norfolk Island
KINGSTON 
Norfolk Island 2899	Perth
Level 13
111 St Georges Terrace
PERTH WA 6000	Sydney
Level 6
83 Clarence St
SYDNEY NSW 2000	
Fax (03) 9454 6998	Tel +61 2 9391 2400
Fax +61 2 9283 4881	Fax (08) 6222 7299	Fax (02) 9276 5599	
If you want more information or assistance, call us on 1800 228 333 (calls are free from landline phones, however calls from mobiles may be charged). Residents of northern NSW (postcodes 2460–2490) will be connected to the Brisbane registry and residents of the Northern Territory will be connected to the Adelaide registry.
Non-English speakers can call the Translating and Interpreting Service on 131 450 and ask them to call the AAT.
If you are deaf or have a hearing or speech impairment, contact us through the National Relay Service. For more information visit: www.relayservice.gov.au.
Website: www.aat.gov.au