ࡱ> uwtq` hMbjbjqPqP iZ::]GV V V V $ NNNPd4 EMB8888H"$****NR*J;BL$5NhPtfL &k"&&fLV V 883L^)^)^)&V 88 8*^)&*^)^)  ^)86 0 \ѝN6' ^)~)M0EM^)QB(Q^)Q ^) %"%^)%%%%%fLfL(d%%%EM&&&& N N V V V V V V   SOUTH AUSTRALIAPRIVATE  MAGISTRATES COURT [CIVIL DIVISION] Form 2 CLAIM ADVANCE \Y 115.90ADVANCE \X 0.0Trial Court:  FORMTEXT      fillin "" \d "" Action No:  FORMTEXT      fillin "" \d "" Address:  FORMTEXT      fillin "" \d "" Telephone:  FORMTEXT      fillin "" \d "" Fax No:  FORMTEXT      fillin "" \d "" Amount Claimed (if any) $ FORMTEXT      fillin "" \d "" Court Fee on Filing  FORMTEXT      fillin "" \d "" Service and Other Fee  FORMTEXT      fillin "" \d "" Solicitor's Fee  FORMTEXT      fillin "" \d "" TOTAL CLAIMED $ FORMTEXT      fillin "" \d "" TYPE OF CLAIM: Building  FORMCHECKBOX  Contract  FORMCHECKBOX  Corporations Law  FORMCHECKBOX  Criminal Assets Confiscation  FORMCHECKBOX  De Facto Relationship  FORMCHECKBOX  Debt  FORMCHECKBOX  Motor Vehicle Property  FORMCHECKBOX  Personal Injury Motor Vehicle  FORMCHECKBOX  Other Personal Injury  FORMCHECKBOX  Equity  FORMCHECKBOX  Retail Shop Lease  FORMCHECKBOX  Workers Lien  FORMCHECKBOX  Other - Specify  FORMCHECKBOX  METHOD OF SERVICE: Registrar  FORMCHECKBOX  Sheriff  FORMCHECKBOX  Plaintiff's Solicitor  FORMCHECKBOX  Party  FORMCHECKBOX  PLAINTIFF/S: Full Name:  FORMTEXT      fillin "" \d "" Address/es:  FORMTEXT      fillin "" \d "" Registered Office, if Body Corporate: Telephone No.: fillin "" \d ""  FORMTEXT       ADVANCE \X 180.0Fax No.:  FORMTEXT      fillin "" \d "" ADVANCE \X 324.0DX No.:  FORMTEXT      fillin "" \d "" Solicitor for Plaintiff/s: Address: Telephone No.: ADVANCE \X 180.0Fax No.: DEFENDANT/S: Full Name:  FORMTEXT      fillin "" \d "" Address/es:  FORMTEXT       fillin "" \d "" Registered Office, if Body Corporate: Telephone No.: fillin "" \d ""  FORMTEXT       ADVANCE \X 180.0Fax No.:  FORMTEXT      fillin "" \d "" ADVANCE \X 324.0DX No  FORMTEXT      fillin "" \d "" Solicitor for Defendant/s(name):  FORMTEXT      fillin "" \d "" Address:  FORMTEXT      fillin "" \d "" Telephone No.: fillin "" \d ""  FORMTEXT       Fax No.: fillin "" \d ""  FORMTEXT       DX No:  FORMTEXT      fillin "" \d "" DEFENDANT/S - If you have a defence or counterclaim you must, within 21 days from receiving 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 fillin "name of defendant" \d "" consent to judgment for the total claimed Date: / / Signature: ................................................. (Defendant/s) 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 (eg. an amount for pain and suffering or economic loss etc.). The plaintiff or his or her solicitor must sign and date each page. There are cost penalties for making an unsuccessful claim or counterclaim. See annexure Date: / / Signature: ................................................. 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  FORMTEXT       with this Claim and Form 17. (Tick the appropriate box)  FORMCHECKBOX  By personal servi "246   $ B D ^ ` t v x    4 ñpjhm@CJUjhm@CJUjQhm@CJUhm@CJjhm@CJU"jhm@CJUmHnHuhm@CJ jhm5@CJUhm5@CJjhm5@CJUhm5@CJ+8F  L 4  , dez n $ 0*$a$ $ 0*$a$$ 0p*$a$ $ q*$a$LLfM4 6 8 B F d f      & * H J t v     0 2 T V j ʻʬʝʎʀwhm>*@CJjhm>*@CJUjhm@CJUjhm@CJUj,hm@CJUjhm@CJUhm@CJ"jhm@CJUmHnHujhm@CJUjnhm@CJU-j l n x |   & > @ \ ^ ` x z Ὧym^mmOmmj|hm@CJUjhm@CJUjhm@CJUhm5@CJ%jhm>*@CJUmHnHu jhm>*@CJUhm>*@CJjhm>*@CJUhm@CJhm>*@CJ%jhm>*@CJUmHnHujhm>*@CJU jIhm>*@CJU  89GHIOP^_`yzܾܯܠܑ܂sjhm@CJUjhm@CJUj6hm@CJUjhm@CJUjNhm@CJUjhm@CJUjdhm@CJUhm@CJjhm@CJUjhm@CJU( 01?@ARSabcdx$&:ܾܵܦܗ܈yܵkjhm5@CJUjV hm@CJUj hm@CJUjj hm@CJUj hm@CJUhm5@CJj~ hm@CJUj hm@CJUhm@CJjhm@CJUjhm@CJU':<>HJLjl@B`bdfz|~  46FH\ººº™ººººº™ºººº{™ºººººj hm@CJUj hm@CJU"jhm@CJUmHnHuj, hm@CJUhm@CJjhm@CJU%jhm5@CJUmHnHujhm5@CJU j hm5@CJU/n :<Z"nrT/Ui $ q*$a$$ 0dh*$a$ $ 0*$a$\^`jn"$:<Trt ʪwj hm@CJU%jhm5@CJUmHnHu j hm5@CJUjhm5@CJUhm5@CJhy5@CJhm@CJ"jhm@CJUmHnHujhm@CJUjL hm@CJU)*,.8<Z\bd(*>@BLPnp*ʻʬʝʎjhm@CJUjhm@CJUj,hm@CJUjhm@CJUhm@CJ"jhm@CJUmHnHujhm@CJUjlhm@CJU7*,.8:vx *.LNTiu02ʻʬʣʣʕʣʣʌrjlhm@CJUhm5>*@CJhm>*@CJjhm>*@CJUhm5@CJj hm@CJUjhm@CJUhm@CJ"jhm@CJUmHnHujhm@CJUjLhm@CJU,ij|~$<<=?$ 0`*$^``a$$ 00*$^`0a$ $ *$a$ $ 0*$a$24>@ <&<(<D<F<H<<<<<<==>>>??6?8?:??????@@@@@BBBٹ٪ٌٛ}njhm@CJUj0hm@CJUjhm@CJUjDhm@CJUjhm@CJUjXhm@CJUUjhm@CJUhm@CJ"jhm@CJUmHnHujhm@CJU+ce on the person.  FORMCHECKBOX  By service on the solicitor acting for the person.  FORMCHECKBOX  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.  FORMCHECKBOX  By depositing it for the person at the DX addressed to the DX number of the person or the solicitor acting for the person.  FORMCHECKBOX  By leaving it at the registered office of the body corporate.  FORMCHECKBOX  By sending it by prepaid post addressed to the strata corporation at its site or its post office box.  FORMCHECKBOX  By pre-paid 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.  FORMCHECKBOX  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.  FORMCHECKBOX  By service on one partner or at the principal place of business of the firm.  FORMCHECKBOX  By sending it by pre-paid post addressed to the person at  FORMTEXT       (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).  FORMCHECKBOX  By EDX to the EDX address given by that person during normal business hours on a normal business day.  FORMCHECKBOX  By  FORMTEXT       (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 the day of 20 Signature ...................................................... ................................................. Person authorised to take Affidavits (eg. Justice of the Peace) PARTICULARS OF CLAIM  FORMTEXT         OFFICE USE ONLY Date of filing: Date of posting: PI MVA-Served SGIC: ??@BCzDFG,H.HHH8I:IJ J"J$JLJNJJJJK$ 00*$^`0a$ $ 0*$a$$ 0`*$^``a$BBBCCCCCDDDDDEE.E0E2EEFFGG GGGGGGHHHHH(H*HdLfLLܾܯ܎ple hm5>*hmjhm@CJUjjhm@CJUjhm@CJU"jhm@CJUmHnHuj~hm@CJUjhm@CJUjhm@CJUhm@CJjhm@CJUjhm@CJU'KK"LdLLLLLLLLLLLLLLLLM:MbMdMfMd 7n*$ $ B#*$a$ $ B#*$a$ $ 0*$a$LLLLLLLLLLLLLLLLLLLbMhMhmCJmH sH  hmCJjhmCJUjhmUmHnHujVhmUjhmUhmfMhM 7n*$4....()()))()00P8$BP. A!"Q#$<%< 1....()()))()0P8$BP. 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