Make a claim


Your claim should include evidence of your right to work in Australia for the period of time relating to your claim, evidence of your employment at the site/s you are making a claim against, evidence that you were underpaid, a statutory declaration and any other supporting evidence you may have.

Where you do not have any evidence of your employment and / or evidence of your underpayment, you can still make a claim by completing the claim form with your details. This will form part of your statutory declaration and Caltex will consider your claim against the evidence it has to support your claim.


Please complete one claim form per site

Your information

**Please provide a mobile phone number as we will text you a code to progress your claim

Address

Employment details

Yes No
Yes No
Yes No
Yes No
Yes No
This file exceeds the limit of 15MB
This file exceeds the limit of 15MB
This file exceeds the limit of 15MB
This file exceeds the limit of 15MB
If you do not provide your TFN declaration, tax will be withheld on any payment at the highest marginal tax rate.
This file exceeds the limit of 15MB

Shift table

In order to calculate your claim (if eligible), we require you to populate the table below. We are not able to calculate the claim if these details are not completed. If a field is not applicable, please enter ‘0’.

Click here for an example of a correctly completed shift table.

1 January 2015
- 30 June 2015
1 July 2015
- 30 June 2016
1 July 2016
- 30 June 2017
1 July 2017
- 30 June 2018
Monday - Friday
Typical hours worked per week
Pay Rate ($)
Typical shift start/end
Saturday
Typical hours worked per week
Pay Rate ($)
Typical shift start/end
Sunday
Typical hours worked per week
Pay Rate ($)
Typical shift start/end
Public Holiday
Typical hours worked on each public holiday
Pay Rate ($)
Typical shift start/end
Training
Estimated total hours of training performed
Pay Rate ($)
Typical shift start/end

Please include any additional comments as needed to further explain your shifts