Form 1—Application for review of decisioForm 1—Application for review of decision

## Form 1—Application for review of decision (subregulation 5(1)) Administrative Appeals Tribunal or Small Taxation Claims Tribunal Application for review of decision ```html <table cellspacing="0" cellpadding="0" style="width:367.28pt; border-collapse:collapse"><tbody><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span style="font-weight:bold"></span></p><p><span style="font-weight:bold">Applicant</span></p><p><span style="font-size:8pt"></span></p><p><span>Full name</span></p></td><td colspan="4" style="width:244.35pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span>Title:</span><span> </span><span>Mr</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>Ms</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>Mrs</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>Miss</span><span> </span><span style="font-family:Wingdings, serif"></span><span> Other.......</span></p><p><span style="font-size:8pt"></span></p><p><span>Family name (surname):</span></p><p><span style="font-size:8pt"></span></p><p style="margin-bottom:2pt"><span>Given names:</span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="width:244.35pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span>Gender</span></p></td><td style="width:71.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span>Male</span><span style="width:26.5pt; display:inline-block"> </span><span style="font-family:Wingdings, serif"></span><span></span></p><p style="margin-top:2pt"><span>Female</span><span style="width:16.72pt; display:inline-block"> </span><span style="font-family:Wingdings, serif"></span></p></td><td style="width:78.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span></span><span>Date of birth</span></p></td><td colspan="2" style="width:72.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span></span></p><p><span></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="width:244.35pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span>Telephone</span></p><p style="margin-top:2pt"><span>(business)</span></p></td><td style="width:71.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span style="font-size:10pt">(</span><span style="font-size:10pt"> </span><span style="font-size:10pt">)</span></p></td><td style="width:78.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span></span><span>Telephone</span></p><p style="margin-top:2pt"><span></span><span>(home)</span></p></td><td colspan="2" style="width:72.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span style="font-size:10pt">(</span><span style="font-size:10pt"> </span><span style="font-size:10pt">)</span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="width:244.35pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Your address</span></p></td><td colspan="4" style="width:244.35pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p><p><span style="font-size:10pt"></span></p><p><span style="font-size:10pt"></span></p><p style="margin-bottom:2pt"><span style="width:143.4pt; font-size:10pt; display:inline-block"></span><span>Postcode</span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="width:244.35pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>The name, address and telephone number of your representative (if you have one)</span></p></td><td colspan="4" style="width:244.35pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="width:244.35pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td colspan="2" style="width:100.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt"><span>Interpreter</span></p></td><td colspan="4" style="width:244.35pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span>Do you require the assistance of an interpreter?</span><span></span></p><p style="margin-top:12pt"><span>Yes</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>No</span><span> </span><span style="font-family:Wingdings, serif"></span></p><p style="margin-top:12pt; margin-bottom:2pt"><span>If yes, for which language?</span></p></td></tr><tr><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Disability</span></p></td><td colspan="4" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span>If you have a disability and need assistance, please indicate:</span></p><p><span style="font-size:6pt"></span></p><p><span>Visual</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>Hearing</span><span> </span><span style="font-family:Wingdings, serif"></span><span> </span><span>Wheel chair user</span><span> </span><span style="font-family:Wingdings, serif"></span></p><p><span style="font-size:6pt"></span></p><p style="margin-bottom:2pt"><span>Other, please specify................................</span></p></td><td style="border-top:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:89.6pt"></td><td style="width:22.15pt"></td><td style="width:82.6pt"></td><td style="width:89pt"></td><td style="width:81.8pt"></td><td style="width:1.75pt"></td></tr></tbody></table> ``` ```html <table cellspacing="0" cellpadding="0" style="width:367.22pt; border-collapse:collapse"><tbody><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span style="font-weight:bold">Decision</span></p></td><td colspan="5" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span>You do not have to answer this question if you can attach a copy of the decision. If you do not have a copy, please describe the decision briefly:</span></p><p><span style="font-size:10pt"></span></p><p><span style="font-size:10pt"></span></p><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span>Date of decision</span></p></td><td style="width:74.65pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td><td colspan="3" style="width:103.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span></span><span>Decision reference</span></p></td><td style="width:65.05pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:2pt"><span>Date you received notice</span></p><p style="margin-bottom:6pt"><span>of the decision</span></p></td><td colspan="5" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt"><span>Who made the decision, if known</span></p></td><td colspan="5" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt"><span>Department or other body:</span></p><p style="margin-top:6pt"><span>Address:</span></p><p><span></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span style="font-weight:bold">Reasons for application</span></p></td><td colspan="5" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span>What are your reasons for seeking review of this decision?</span></p><p style="margin-left:8.75pt; text-indent:-8.75pt"><span style="font-size:10pt"></span></p><p style="margin-left:8.75pt; text-indent:-8.75pt"><span style="font-size:10pt"></span></p><p style="margin-left:8.75pt; text-indent:-8.75pt"><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span style="font-weight:bold">Tax matters</span></p><p><span></span></p><p><span></span></p></td><td colspan="5" style="width:264.75pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span>Please state the amount of tax in dispute (only answer this question if you want a tax decision reviewed).</span></p><p><span></span></p><p style="margin-bottom:2pt"><span>$</span></p></td></tr><tr><td style="vertical-align:top"></td><td style="width:78.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="width:264.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span style="font-size:10pt"></span></p></td></tr><tr style="height:27.6pt"><td colspan="2" style="width:80.5pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span>Signature</span></p></td><td colspan="2" style="width:138.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p><span style="font-size:10pt"></span></p><p><span style="font-size:10pt"></span></p></td><td style="width:31.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:2pt; margin-bottom:2pt"><span></span><span>Date</span></p></td><td colspan="2" style="width:72.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-left:1.65pt"><span style="font-size:10pt"></span></p></td></tr><tr style="height:0pt"><td style="width:1.7pt"></td><td style="width:89.6pt"></td><td style="width:85.45pt"></td><td style="width:64.25pt"></td><td style="width:42.55pt"></td><td style="width:7.45pt"></td><td style="width:75.85pt"></td></tr></tbody></table> ```