Completed forms must be emailed to

Gauteng, Limpopo and North West - [email protected]

KwaZulu-Natal, Free State and Mpumalanga - [email protected]
Western Cape, Eastern Cape and Northern Cape - [email protected]

APPLICATION FOR DISPUTE RESOLUTION FORM

Kindly complete the form in a legible manner and all pages must be completed.

Details of person making this Application:

Please fill in Block Letters
Full Names:
Surname:
ID Number:
Tel No: (home/work): Cell Phone:
Email:
Race: Age: Gender: Male

Address:
Name of Scheme: Unit No:
Street Name:
Suburb:
City:
Province: Postal Code:

Postal address of Applicant (if different from above):

PO Box No: Suburb:
City:
Province: Postal Code:

The application pertains to which type of Community Scheme living:

Tick Applicable 
Sectional Title Development Homeowners Association
Housing Scheme for Retired Persons Share Block Company
Housing Cooperative Other (please specify)

Person / Association making the application (Applicant):

Tick Applicable 
Owner Occupier Management Agent
Board of Directors Sectional Title Trustees Management Association for Retired Persons
Other (please specify)

Has legal proceedings been instituted i.e. Summons, Administration Order herein:

Yes No Not sure

Details of person(s) / Community Scheme you are making the application against:
(If more than one person, please state details under additional information)
Details:
Address:
Tel No: (home/work):
Email:

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Details of application/alleged breach:
Please legibly set out all the facts which you consider to have bearing on this application, including dates, places and
persons involved.

Exhaustion of internal remedies:

What has been done to try to resolve this application? Please describe what you have done, who you have talked to and
what they offered to do.

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Relief sought:
What remedy are you requesting? How do you want the problem to be solved?

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Additional Information:

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Supporting documentation
Please tick one or more of the boxes 
I have supporting documentation or other evidence to supply with my application:
A copy of Scheme Governance documentation (including: any rules, regulations, articles, constitution, terms and conditions or
other provisions that control the administration or occupation of private areas and common areas)
A copy of Sectional Title / Homeowners Association Plan
A copy of the Title Deed
All documentation, including correspondence with the Respondent (party you are making the application against) relevant to
the application
A copy of your latest statement of account
A copy of the minutes of the Annual / Special General Meeting
Photographs
A copy of audited financial statements
A copy of Summons
A copy of Administration Order
Other (please specify)
I do not have supporting documentation

Declaration and Signature of applicant:

I declare that the above information is true and correct to the best of my knowledge. I agree that the information I have given in this
form may be used or disclosed to process and resolve this application.

Signature:

/ / 2 0 1 9
(dd/mm/yy)

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