Ucpr Form 3a v71
Ucpr Form 3a v71
Ucpr Form 3a v71
UCPR 6.2
STATEMENT OF CLAIM
COURT DETAILS
Court
#Division
#List
Registry
Case number
TITLE OF PROCEEDINGS
[First] plaintiff [name]
#Second plaintiff #Number of [#name #number
plaintiffs (if more than two) Refer to Party Details at rear for full list of parties]
[First] defendant [name]
TYPE OF CLAIM
[Select type of claim from the list available on the UCPR website at www.ucprforms. nsw.gov.au by clicking on the
link to Publications, or at any NSW court registry]
2
[Note: If the completed RELIEF CLAIMED will fit in the available space appearing after TYPE OF CLAIM on the
first page of this form, you may delete the page break, include the RELIEF CLAIMED on the first page and start
this page with PLEADINGS AND PARTICULARS.]
RELIEF CLAIMED
1
2
[If you are making a liquidated claim (ie claiming a specific amount of money), include the following information:]
1
2
#This statement of claim does not require a certificate under clause 4 of Schedule 2 to the
Legal Profession Uniform Law Application Act 2014.
#I certify under clause 4 of Schedule 2 to the Legal Profession Uniform Law Application Act
2014 that there are reasonable grounds for believing on the basis of provable facts and a
reasonably arguable view of the law that the claim for damages in these proceedings has
reasonable prospects of success.
I have advised the plaintiff[s] that court fees may be payable during these proceedings.
These fees may include a hearing allocation fee.
Signature
NOTICE TO DEFENDANT
If you do not file a defence within 28 days of being served with this statement of claim:
The court may enter judgment against you without any further notice to you.
The judgment may be for the relief claimed in the statement of claim and for the plaintiff’s
costs of bringing these proceedings. The court may provide third parties with details of any
default judgment entered against you.
HOW TO RESPOND
Please read this statement of claim very carefully. If you have any trouble
understanding it or require assistance on how to respond to the claim you should get
legal advice as soon as possible.
You can get further information about what you need to do to respond to the claim from:
A legal practitioner.
1 If you intend to dispute the claim or part of the claim, by filing a defence and/or
making a cross-claim.
2 If money is claimed, and you believe you owe the money claimed, by:
Paying the plaintiff all of the money and interest claimed. If you file a notice
of payment under UCPR 6.17 further proceedings against you will be
stayed unless the court otherwise orders.
Filing an acknowledgement of the claim.
Applying to the court for further time to pay the claim.
3 If money is claimed, and you believe you owe part of the money claimed, by:
REGISTRY ADDRESS
Street address
Postal address
Telephone
5
[Do not include the affidavit verifying in Local Court proceedings. Refer to the Uniform Civil Procedure Rules 2005
for other circumstances where affidavit not required.]
#AFFIDAVIT VERIFYING
Name
Address
Occupation
Date
2 I believe that the allegations of fact in the statement of claim are true.
Identification document relied on (may be original or certified copy) †
Signature of witness
Note: The deponent and witness must sign each page of the affidavit. See UCPR 35.7B.
____________________________
[* The only "special justification" for not removing a face covering is a legitimate medical reason (at April 2012).]
[†"Identification documents" include current driver licence, proof of age card, Medicare card, credit card,
Centrelink pension card, Veterans Affairs entitlement card, student identity card, citizenship certificate, birth
certificate, passport or see Oaths Regulation 2011.]
6
#PARTY DETAILS
[Include only if more than two plaintiffs and/or more than two defendants.]
[name] [role of party eg first plaintiff] [name] [role of party eg first defendant]
[repeat as required for each additional plaintiff] [repeat as required for each additional defendant]
[repeat the above information as required for the second and each additional plaintiff]
Telephone
Fax
Email
Electronic service address [#email address for electronic service eg
service@emailaddress.com.au #Not applicable]
7
[repeat the above information as required for the second and each additional defendant]