Magistrates Court (Civil Jurisdiction) Rules 2004—Form 6 Small Claims Court
(see s 417 (1) (b))
Default judgment application
Application No		of [year], between [applicant] and [respondent].
To the Registrar:
The applicant applies for the entry of judgment in these proceedings against the respondent.
* Specified amount
Fee for commencing proceedings:	$	
Charges and out-of-pocket expenses:	$	
Amount claimed:	$	
Particulars of interest:
•	period(s) for which interest is claimed:
•	rate(s) at which interest is claimed:
•	total interest accrued to date:	

$	
Total:	$	
* Debt declaration
Fee for commencing proceedings:	$	
Charges and out-of-pocket expenses:	$	
Total amount in relation to which declaration is sought:	$	
* Unspecified amount—interim order sought
The applicant applies to the Registrar for an interim order in relation to—
* the whole application.
* the following part of the application:
Date:
[signed]
Applicant
* Strike out where inapplicable

Endnotes
1	This form was originally in the Magistrates Court (Civil Jurisdiction) Act 1982 (the authorising Act), schedule 2.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the authorising Act and became a form approved under section 471 of that Act (see amdt 1.2791, amdt 1.2793).  
2	This republication includes amendments made under the Legislation Act, part 11.3 (Editorial changes).

©  Australian Capital Territory 2005