Instructions for completion
Application – Human Rights
1.	This form is used for commencing an application in the Federal Circuit and Family Court of Australia alleging unlawful discrimination under the Australian Human Rights Commission Act 1986: see rule 26.03(1) of the Federal Circuit and Family Court of Australia (Division 2)(General Federal Law) Rules 2021 (the Rules).
2.	You must complete address for service details in the footer on page 1. All correspondence concerning the application will be sent to the email address or mailing address inserted and all documents in the proceedings will be deemed to have been served on you if emailed or posted to that address. If your address details change, you must file a notice of address for service within 7 days of the change and serve a copy on all other parties: see rule 6.02 of the Rules. 
3.	You must insert the name/s and address/es of each respondent in the ‘Important Notice to Respondent/s’ box at the end of the form.
4.	The grounds of the application must explain briefly the basis on which the orders are sought. Provided you complete this application form satisfactorily, you do not need to file a supporting affidavit or pleading. However, if you do not fully complete this form, you may also need to file either a pleading by way of a statement of claim or points of claim, or an affidavit setting out the evidence supporting your application. If you file a pleading it should comply with Part 16 of the Federal Court Rules 2011 and it should identify in summary form the material facts on which you rely, but not the evidence by which those facts are to be proved. 
5.	You must attach a copy of the complaint that you made to the Australian Human Rights Commission and a copy of the notice of termination to this application. 
6.	If this application is more than 60 days after the date on the notice of termination, you will need to seek an extension of time by completing Part E of this application form.
7.	Unless the Court orders otherwise, an application filed (and other documents filed with it) may not be served less than seven days before the day fixed for the hearing of the application: rule 6.19 of the Rules. Service must be by hand, unless the Court otherwise orders. The application and other documents must be served on each party and the person against whom orders are sought if that person is not a party. You must also give a sealed copy of the application, and any other documents filed with the Court, to the Australian Human Rights Commission at least five days before the date fixed for the hearing: see rule 26.04 of the Rules.
8.	If you are completing this application by hand and you need more space in any section, attach extra page/s as required.
9.	Once complete, you need to file the original and a copy of this application for each party to the matter, and a copy for the Australian Human Rights Commission, with the court registry. The Court will keep the original and return the sealed copies to you. You will need to serve a sealed copy on the other party or parties, and the Commission, and keep a copy for your records.

Remove this instruction sheet before filing

IN THE FEDERAL CIRCUIT AND				File number: .....................................
FAMILY COURT OF AUSTRALIA
REGISTRY: ........................................................
......................................................................
Applicant
.....................................................................
Respondent
Repeat as necessary for additional parties
Application – Human Rights
Type of application
This application alleges unlawful discrimination under section 46PO of the Australian Human Rights Commission Act 1986.
First court date
This application is listed for hearing at (court location): ......................................................................
Court date and time (registry staff to insert):					 at 	am/pm.
All parties or their legal representatives should attend this hearing. Default orders may be made if any party fails to attend. The Court may hear and determine all interlocutory or final issues, or may give directions for the future conduct of the proceeding.

(for) Registrar  
Date: ........../.........../..............	
Filed on behalf of	     	
Prepared by	     	Lawyer’s code	     	
Name of law firm	     	
Address for service in Australia	     	
	     	State	     	Postcode	     	
Email	     	
Tel	     	Fax	     	Attention	     	

Part A – Orders sought 	
1.  Pursuant to subsection 46PO(3A) of the Australian Human Rights Commission Act 1986, an application can only be brought to the Court in certain circumstances. Please select the most appropriate: 
	 I request leave of the Court to make this application
If leave of the Court is requested, an Affidavit is to be filed specifying the reasons the Applicant considers that leave ought to the granted.
 The President of the Australian Human Rights Commission has indicated that the subject matter of the complaint involves an issue of public importance that should be considered by the Federal Court of Australia or the Federal Circuit and Family Court of Australia.
 The President of the Australian Human Rights Commission has indicated that there is no reasonable prospect of the matter being settled by conciliation
	
2. Final orders sought by applicant/s 
State precisely each order sought by way of final relief. Examples of remedies include an apology from the respondent, employment or re-employment, and compensation.

If you seek compensation you must provide details of how much compensation you are claiming and how the amount has been calculated; for example, loss of income
	1.	     
2.	     
3.	     

	
3. Interlocutory, interim or procedural orders sought by applicant/s
Complete only if interlocutory, interim or procedural orders are sought

	1.	     
2.	     
3.	     

	
Part B – Grounds of Application	
4. What discrimination are you complaining of?
The unlawful discrimination must:
(a)	 be the same or substantially the same as the discrimination that was the subject of the complaint terminated by the Australian Human Rights Commission, or
(b) 	arise out of the same or substantially the same acts, omissions or practices that were the subject of complaint. 	     

	
5. Under what Act is the discrimination you are complaining of unlawful?	 the Age Discrimination Act 2004
 the Disability Discrimination Act 1992
 the Racial Discrimination Act 1975
 the Sex Discrimination Act 1984	
6. State all sections of the Act that are relevant to this claim	     
	
Part C – The applicant/s 	
7. Full name(s)
Attach extra page for any additional applicants	 Mr   
 Mrs  
 Ms	Family name: 	     	
		Given names:	     	
8. Home or contact address (including postcode)	     	
9. Telephone/Fax No.	Business hours:	     	After hours:	     	
	Fax no:	     	
1. Are you over 18 years?	 Yes    No	
11. What is your first language? 
This includes languages such as Sign and Auslan	     	
12a. Do you need an interpreter at the hearing?
12b. If yes, please state language or type	 Yes    No	
	     	
13. Do you have any special requirements?
If yes, please give details; for example, wheelchair access, hearing loop, presence of personal assistant or carer. 	 Yes    No
     	
Part D – The respondent/s	
14. What is your relationship to the person or organisation against whom you bring this application?

	  Employee of person/organisation
  Former employee of person/organisation
  Co-employee
  Customer of person/organisation
  Other (please specify)      	
Part E – Extension of time	
15. Do you need an extension of time?
You must complete this section if your application and claim is made more than 60 days after the date of issue of written notice of the termination of the complaint by the President of the Australian Human Rights Commission. If yes, please provide reasons.	 Yes    No

     	
Part F – Required documents	
15. These documents must accompany your application and claim	 	A copy of your original complaint to the Australian Human Rights Commission (if available).
 	The notice of termination of complaint given by the President of the Australian Human Rights Commission	

Signature of applicant/s or lawyer
	
Signed by (print name/s) ................................................. 
 the applicant/s or  	lawyer for the applicant/s
Date: ............/............/...........	

IMPORTANT NOTICE TO RESPONDENT/S
To the respondent (name): ...............................................................................................................................................
of (address): ...............................................................................................................................................
If there are two or more respondents, provide details: .............................................................................
You should seek legal advice about this application. You may file a response. If you file a response, you must file and serve the response within 28 days of receiving this application. If you do not file a response, you must file and serve a notice of address for service before the hearing.	

Form approved by the Chief Judge pursuant to Subrule 2.04(1) for the purpose of subrule 26.03(1) 
HR_Application_0921V1