Current Page 1 Page 2 Page 3 Page 4 Complete ✔Complete the formMake sure all sections are complete on this form before submitting 📄Supporting DocumentsPlease ensure you attach all supporting documents to your claim 💳Submit FormSubmit this form and supporting documents to Council Claiming Fuel Cost AdjustmentOnly one fuel cost adjustment claim may be submitted per adjustment period under this contract.That claim may include multiple transport activities, deliveries, subcontractor costs or transport cost reference portions, provided all relate to road transport work performed during the same adjustment period, all claims use the same baseline fuel price and fuel price index specified in Schedule A, and the total of the claim for all activities does not result in duplication or double recovery of the same transport cost. Part A – Contractor and Contract Details Contract Title Contract Number Contract Variation Reference (if applicable) Contractor Name ABN Your Name Position Phone Email Next Page Leave this field blank
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