Eircode / Country: Postcode: Telephone: Mobile: Fax Email: (0ptional): Name of Senior Contact Person (if known): PART B: Payment dispute details Does the payment dispute arise under a construction contract as defined Yes No in the Construction Contracts Act, 2013? State the Payment Claim Date for the amount in dispute: € State the amount in dispute (even if the amount is zero): State the amount in words: Describe the payment dispute from the following options: Failure to make an interim payment Failure to make a final payment Other payment dispute (please specify) Continue on separate sheet if needed Provide any additional information considered relevant to the payment dispute:
Country: Eircode / Postcode: Telephone: Mobile: Email: Fax (0ptional): Name of Senior Contact Person (if known): PART B: Payment dispute details Does the payment dispute arise under a construction contract as defined in the Construction Contracts Act, 2013? Yes No State the Payment Claim Date for the amount in dispute: State the amount in dispute (even if the amount is zero): € State the amount in words: Describe the payment dispute from the following options: Failure to make an interim payment Failure to make a final payment Other payment dispute (please specify) Continue on separate sheet if needed Provide any additional information considered relevant to the payment dispute:
Form-4-Notice-of-Intention-to-Refer-Payment-Dispute-for-Adjudication.docx