ࡱ> a bjbjڥڥ 8R\R\R88%%%%%%%%8%,(&%T':'((((R)>)) rTtTtTtTtTtTtT$WYT%)R)R)))T%%((4T(.(.(.)%(%(rT(.)rT(.(.2M|P(k'\*^O.^TT0TOZ*Z\|P|P"Z%P))(.)))))TTz,)))T))))Z)))))))))8> v$: Application for compensation Motor Car Traders Guarantee Fund Motor Car Traders Act 1986 Warning: Enter text in spaces provided only. The Motor Car Traders Claims Committee will not accept your form, nor consider it lodged, if you remove or change any questions or other text. Before completing this form, please read the information at HYPERLINK "http://www.consumer.vic.gov.au/motor-cars/compensation-claims"HYPERLINK "http://www.consumer.vic.gov.au/motor-cars/compensation-claims" \o "Compensation claims - motor cars - Consumer Affairs Victoria website"consumer.vic.gov.au/motorcarclaims Applicants details NameAddress (including postcode)Date of birthDaytime telephone number (mobile ok)EmailOccupationWould you like to receive communications from the Motor Car Traders Claims Committee in relation to your claim via email? YesNoMotor car traders details NameBusiness address (including postcode)Business telephone numberBusiness mobile numberLicensed motor car trader numberVehicle details Registration numberState registeredMake and modelYearTransaction details Date of transaction (dd/mm/yyyy)Purchase priceGrounds for claim (Section 76, Motor Car Traders Act 1986) Mark appropriate boxes with an X. If the reasons on which you are relying on to make a claim are not listed here, please contact the Motor Car Traders Claims Committee on 1300 135 452. Consignment selling by trader - 76(1)(a)Odometer tampering by trader - 76(1)(a)Sale of trade-in during cooling-off period - 76(1)(a)Failure to comply with statutory warranty - 76(1)(a)Failure to display notice that statutory warranty does not apply - 76(1)(a)Special condition limiting or modifying statutory warranty / defects notice - 76(1)(a)Failure to cancel security interest - 76(1)(b)(i)Purchase of suspected stolen car which has been seized by Police - 76(1)(b)(ii)Failure of trader to pay or remit purchase price - 76(1)(c)Failure of trader to pay transfer fees, stamp duty or to transfer ownership - 76(1)(d)Failure of trader to forward payment for price of warranty or insurance policy - 76(1)(e)Failure of trader to satisfy a Tribunal or Court order - 76(1)(f)Failure of trader to return deposit as agreed following termination of contract of sale - 76(1)(g)Failure of trader to deliver a motor car after receiving payment 76(1)(h)Amount claimed ItemAmount ($)TotalDescription of circumstances giving rise to the claim I believe that I am entitled to compensation for the following reasons (please give a full description of events that led up to this claim, including details of all your dealings with the motor car trader). If you need more space, please attach further documents.  Have you taken steps to resolve this matter, such as contacting Consumer Affairs Victoria? YesNoIf yes, please provide description Document checklist It will assist the Committees consideration of your claim if you attach copies of all documents relevant to this application. These may include: Contract of sale Invoices Finance agreement Receipts and cheques (or cheque butts) Independent mechanical reports Quotes and invoices for repair work Roadworthy certificate(s) A warrant authorising Police to seize a motor car suspected of being stolen Correspondence between you and the motor car trader, finance companies or VicRoads Any other documents, including any emails, you feel are relevant to your claim If you do not have documentation, explain here Certification and acknowledgement I certify that the particulars contained in this claim, including all attachments, are true and correct. I acknowledge that I am aware that making a false or misleading statement is an offence under section 84A of the Motor Car Traders Act 1986 with a maximum penalty of 50 penalty units in the case of a natural person and 100 penalty units in the case of a company. (penalty unit: $151.67) I acknowledge that a copy of this claim will be provided to the motor car trader concerned and may be provided to other agencies or bodies for the purpose of confirming information provided or to obtain further information necessary to consider this claim. I declare that I have not and do not intend to make a claim for payment or any other form of compensation in respect of this matter from another party or insurer. I consent to the Committee referring this claim to Consumer Affairs Victoria for dispute resolution, if appropriate. SignatureFull nameDate (dd/mm/yyyy)Privacy The Motor Car Traders Claims Committee is committed to responsible and fair handling of personal information, consistent with the Information Privacy Principles set out in the Privacy and Data Protection Act 2014. These principles cover the collection, use and disclosure of personal information. To enable it to carry out its function of determining claims, the Committee will provide a copy of a claim to the motor car trader against whom the claim is made to give them an opportunity to respond. Information provided to the Committee by the motor car trader in answer to the claim may be given to the person making the claim. The Committee may also need to disclose personal information to other State or Commonwealth agencies or other persons who have a relevant involvement in the transaction leading to the claim. For more information, view the HYPERLINK "http://www.consumer.vic.gov.au/privacy"Privacy statement page on the Consumer Affairs Victoria website (consumer.vic.gov.au/privacy). 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