Before completing this form, please read the Payment Notice Dispute Guidelines
If you are unable to fill out this form online for any reason, please download and fill out the form here
Provide details of person to whom notice was issued
Payment Notice - Provide details of payment notice you are disputing
Explain what you would like to see happen as a result of your complaint
Please attach any supporting information and evidence you have to assist the disputes officer in the review of your complaint.
Accepted file types: jpg, gif, png, pdf.