Dispute Notice Form

A completed copy of this form must also be provided to the Trainer.

Horse Description

Horse Name *

Foal Date of Birth *

Microchip Number *

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Trainer Details

Date of Birth

Surname of Trainer *

Given Names of Trainer *

Postal Address *

Postal Address

City

State

Postcode

Country

Email Address *

Mobile *

Daytime Phone *

Owner Details

Date of Birth

Surname of Owner *

Given Names of Owner *

Postal Address *

Postal Address

City

State

Postcode

Country

Email Address *

Mobile *

Daytime Phone *

Disputed Invoice Details

Attach disputed invoices with this form together with any supporting documentation on which you intend to rely

Invoice *

Full Invoice

Part Invoice

For an Invoice which is partly in dispute, please indicate clearly the part of the invoice in dispute and whether the part not in dispute has been paid to the Trainer.

Date of Invoice *

Date of Invoice Received *

if different to the date of invoice

Brief Description of Nature of Dispute *

Disputed Amount *

Upload Invoice Copy *

Maximum file size: 516MB

Add Invoice Remove Invoice

Fee Notice

A Fees Notice was Received *

Yes

No

Date *

Fees Notice Template *

Template Fees Notice used

Alternative Fees Notice used

Upload Fees Notice / Alternative Fees Notice *

Maximum file size: 516MB

Signature *

Clear