Minor civil action claim magistrates Court of South Australia



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Form 3

MINOR CIVIL ACTION - CLAIM

Magistrates Court of South Australia (Civil Division)

www.courts.sa.gov.au




Court Use

Date Filed

Date of Posting

PI MVA – Served Allianz:






Trial Court

     

Action No

     

Address

     

     

     

     

Street

Telephone

Facsimile

DX

     

     

     

     

City/Town/Suburb

State

Postcode

Email Address

Amount Claimed (if any)

$     

Court Fee on Filing

$     

Service and Other Fee

$     

Solicitor’s Fee

$     

TOTAL CLAIMED

$     

Type of claim (tick)

 Building

 Contract

 Corporations Law

 Debt

 Motor Vehicle Property

 Personal Injury Motor Vehicle

 Other Personal Injury

 Other (specify)

 Construction Contract Payment

Method of service (tick)

 Registrar

 Sheriff

 Plaintiff’s Solicitor

 Party

Plaintiff/s

Full Name

     

Address

(Registered Office, if Body Corporate)

     

     

     

     

Street

Telephone

Facsimile

DX

     

     

     

     

City/Town/Suburb

State

Postcode

Email Address

Solicitor for Plaintiff/s (name)

(A solicitor is not required – the solicitor cannot appear at trial)

     

Address

     

     

     

     

Street

Telephone

Facsimile

DX

     

     

     

     

City/Town/Suburb

State

Postcode

Email Address

Defendant/s

Full Name

     

Address

(Registered Office, if Body Corporate)

     

     

     

     

Street

Telephone

Facsimile

DX

     

     

     

     

City/Town/Suburb

State

Postcode

Email Address

Solicitor for Defendant/s (name)

(A solicitor is not required – the solicitor cannot appear at trial)

     

Address

     

     

     

     

Street

Telephone

Facsimile

DX

     

     

     

     

City/Town/Suburb

State

Postcode

Email Address

PARTICULARS: State what you want from the Court. Briefly state the date, place and circumstances from which the claim arose. Where the claim is for damages the amount claimed for each head of damages must be given (e.g. an amount for pain and suffering or economic loss etc.). The plaintiff or his/her solicitor must sign and date each page. There are cost penalties for making an unsuccessful claim or counterclaim.

     


Date PLAINTIFF



DEFENDANT/S - If you have a defence or counterclaim you must, within 21 days from service of this claim, go to your nearest court and file a defence and/or counterclaim.

TAKE THIS FORM WITH YOU

If you do nothing, the plaintiff may get judgment against you.

If you consent to judgment, please sign and return this form to the Trial Court (address above).

I,       consent to judgment for the total claimed.

Date DEFENDANT






AFFIDAVIT OF PROOF OF SERVICE


I,       of      


Occupation:

     

MAKE OATH AND SAY that:

I. I did on the       day of       20     , between the hours of       and       duly serve the within named defendant       with this claim and Form 17 and any applicable form under the Service and Execution of Process Act 1992 (Cth).

(Please tick the appropriate box)

 By personal service on the person.

 By service on the solicitor acting for the person.

 By leaving it for the person at the address of the place of dwelling or business of the person with someone apparently above the age of 14 years.

 By depositing it for the person at the DX addressed to the DX number of the person or the solicitor acting for the person.

 By leaving it at the registered office of the body corporate.

 By sending it by prepaid post addressed to the strata corporation at its site or its post office box.

 By prepaid post addressed to the community corporation or to the presiding officer, treasurer or secretary at the postal address of the community corporation or by placing it in the community corporation’s letterbox.

 By fax directed to the fax number of the person or the solicitor acting for the person during normal business hours on a business day.

 By service on one partner or at the principal place of business of the firm.

 By sending it by prepaid post addressed to the person at -      

(note - unless the court is satisfied that the document served by this method came to the attention of the defendant the plaintiff is not entitled to costs thrown away if the judgment is set aside-rule 106(8))



 By      

(here describe any other authorised means of service)



II. I served the person at (state the address, DX number, fax number etc.)      

III. I necessarily made       trips and travelled       kilometres for the purpose of effecting the service.

SWORN before me at      

on the       day of       20     

Signature

(Person authorised to take Affidavits)



(e.g. Justice of the Peace)

SERVER


Gov. Gaz. 26 April 2013, p 1200

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