NSW UCPR Form 3B Statement Of Claim Filing Party Acting In Person Or By Authorised Officer ZIGGY D Zz

User Manual: ZIGGY

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Form 3B (version 1)
UCPR 6.2
STATEMENT OF CLAIM
COURT DETAILS
Court
#Division
#List
Registry
Case number
TITLE OF PROCEEDINGS
[First] plaintiff [name]
#Second plaintiff #Number of
plaintiffs (if more than two) [#name #number
Refer to Party Details at rear for full list of parties]
[First] defendant [name]
#Second defendant #Number of
defendants (if more than two) [#name #number
Refer to Party Details at rear for full list of parties]
FILING DETAILS
Filed for [name] plaintiff[s]
Contact name and telephone [name] [telephone]
TYPE OF CLAIM
[Select type of claim from the list provided in section 6 of the Guide to preparing documents, available on the
UCPR website at http://www.lawlink.nsw.gov.au/ucpr or at any NSW court registry.]
2
[on separate page]
[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:]
Amount of claim $
Interest $
Filing fees $
Service fees $
Solicitors fees $
TOTAL $
PLEADINGS AND PARTICULARS
1 [ ]
2 [ ]
SIGNATURE
I acknowledge that court fees may be payable during these proceedings. These fees may
include a hearing allocation fee.
Signature
Capacity [eg authorised officer, role of party]
Date of signature
NOTICE TO DEFENDANT
You will be in default 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.
3
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 respond in one of the following ways:
1 If you intend to dispute 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:
• Paying the plaintiff that part of the money that is claimed.
• Filing a defence in relation to the part that you do not believe is owed.
You can get further information about what you need to do to respond to the claim from:
• The court registry.
• A legal practitioner.
• LawAccess NSW on 1300 888 529 or at www.lawaccess.nsw.gov.au.
Court forms are available on the UCPR website at www.lawlink.nsw.gov.au/ucpr or at any
NSW court registry.
REGISTRY ADDRESS
Street address
Postal address
Telephone
4
[on separate page]
[Do not include the affidavit verifying in Local Court proceedings or in Supreme or District Court proceedings for
the recovery of damages for defamation, malicious prosecution, false imprisonment, trespass to the person,
death or personal injury or if verification has been dispensed with by the court.]
#AFFIDAVIT VERIFYING
Name
Address
Occupation
Date
I [#say on oath #affirm]:
1 #I am the [first] plaintiff.
#I am [give details of the capacity of the person making the affidavit and the facts
that qualify the person to make the affidavit].
2 I believe that the allegations of fact in the statement of claim are true.
#SWORN #AFFIRMED at
Signature of deponent
Signature of witness
Name of witness
Address of witness
Capacity of witness [#Justice of the peace #Solicitor #Barrister #Commissioner for
affidavits #Notary public]
5
[on separate page]
#PARTY DETAILS
[Include only if more than two plaintiffs and/or more than two defendants.]
PARTIES TO THE PROCEEDINGS
Plaintiff[s] Defendant[s]
[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]
FURTHER DETAILS ABOUT PLAINTIFF[S]
[First] plaintiff
Name
#[unit/level number] #[building name]
[street number] [street name] [street type]
[suburb/city] [state/territory] [postcode]
Address
[The filing party must give the party's
address.]
#[country (if not Australia)]
#Frequent user identifier [include if the plaintiff is a registered frequent user]
[repeat the above information as required for the second and each additional plaintiff]
Contact details for plaintiff acting in person or by authorised officer
#Name of authorised officer
#Capacity to act for plaintiff
#as above
#[unit/level number]
#[building name]
[street number] [street name] [street type]
Address for service
[The filing party must give an address for
service. This must be an address in
NSW unless the exceptions listed in
UCPR 4.5(3) apply. State "as above" if
the filing party’s address for service is
the same as the filing party's address
stated above.]
[suburb/city] [state/territory] [postcode]
#Telephone
#Fax
#Email
DETAILS ABOUT DEFENDANT[S]
[First] defendant
Name
#[unit/level number] #[building name]
[street number] [street name] [street type]
[suburb/city] [state/territory] [postcode]
Address
#[country (if not Australia)]
[repeat the above information as required for the second and each additional defendant]

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