Home Application forms COVID-19 Dispute Form Application formsCOVID-19 Dispute Form For referral of a dispute about temporary leasing arrangements under the Victorian Government Commercial Tenancies Support Scheme for SME Leases during coronavirus (COVID-19)Before completing this application form, please consider talking this matter over with your solicitor or contacting the Victorian Small Business Commission on 13 VSBC (13 8722).Note: the details you provide in this Application, and any accompanying documents, may be forwarded to the Respondent. Submission of this Referral Form indicates your agreement to this.Applicant DetailsTo enable us to assist you better, please answer the following questions:Have you had any previous contact with this Office by phone or e-mail in relation to this matter?*YesNoAre you a Tenant or Landlord?TenantLandlordWhat is the size of your business?*0 employees1-4 employees5-19 employees20-199 employees200+ employeesIs the turnover of your business up to $50 million?YesNoAre you a participant in the Commonwealth Government’s Jobkeeper scheme*YesNoPlease attach evidence (for example, Jobkeeeper enrolment confirmation)*What per cent reduction in turnover has your business experienced due to the impact of coronavirus (COVID-19)?*Please attach evidence of reduction in turnover*Tenancy DetailsType of lease*RetailCommercialPlease attach a copy of your lease*Tenant’s name on leaseBusiness or Trading Name (if applicable)Shopping Centre (if applicable)Street Address, including shop number(s) if applicable, and Suburb/City/Town*PostcodeType of use of the premises*Date of commencement of the current lease or lease extension* Date Format: MM slash DD slash YYYY Applicant Details (i.e. name of person or company referring dispute)If there is more than one applicant, provide the name and address of the second and subsequent applicants, and of their representatives, using copies of the attachment to this formIf the tenant or landlord is represented by an agent or solicitor, please provide the name, address and contact telephone numbers for BOTH the tenant or landlord AND agent or solicitor. Status of person or company referring disputeLandlordTenantApplicant typeCompanyNot a companyCompany Name*Company ACN or ABN (if known)Name of natural person contact for applicant*Name*Street or postal address* Street Address Address Line 2 City State Postcode Phone*Email (if applicant has an email address) Name of representative of applicant (e.g. solicitor or estate agent)Street or postal address Street Address Address Line 2 City State Postcode PhoneEmail (if representative has an email address) Respondent Details (i.e. name of other party to dispute, being a person or company)If there is more than one respondent, provide the name and address of the second and subsequent respondents, and of their representatives, using copies of the attachment to this formIf the tenant or landlord is represented by an agent or solicitor, please provide the name, address and contact telephone numbers for BOTH the tenant or landlord AND agent or solicitor. Status of respondentLandlordTenantRespondent typeCompanyNot a companyCompany Name*Company ACN or ABN (if known)Name of natural person contact for respondent*Name*Street or postal address* Street Address Address Line 2 City State Postcode Phone*Email (if respondent has an email address) Name of representative of respondent (e.g. solicitor or estate agent)Street or postal address Street Address Address Line 2 City State Postcode PhoneEmail (if representative has an email address) Dispute Details (Brief description of dispute)*If you wish to provide additional documents on this matter (eg lease), please attach using the file upload below or separately forward under cover of a letter to the Victorian Small Business Commission (clearly identifying the dispute and providing reference number if issued).Dispute Documents Drop files here or Relief claimed*Before you submit this application form, we would appreciate receiving your feedback:How did you hear about this Office?WebsiteRadioPrint mediaPresentation made by the Commissioner or a representativeYour lawyerYour accountantIndustry associationPlease rate your experience with: Locating this application form on our websiteVery EasyEasyAverageDifficultVery DifficultPlease rate your experience with: Completing this application formVery EasyEasyAverageDifficultVery DifficultPlease feel free to add any additional comments about the application formAttachmentTo be used if there is more than one applicant or respondent, to provide the name and address of the second and subsequent applicants or respondents, and of their representatives.If the tenant or landlord is represented by an agent or solicitor, please provide the name, address and contact telephone numbers for BOTH the tenant or landlord AND agent or solicitor. Information relating toApplicantRespondentApplicant / Respondant typeCompanyNot a companyCompany Name (if company)Company ACN or ABN (if known)Name of natural person contact for applicant (if company)Name (if not company)Street or postal address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail (if applicant has an email address) Name of representative of applicant (e.g. solicitor or estate agent)Street or postal address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail (if representative has an email address) Add another Applicant or RespondantRemove this Applicant / RespondantNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
