Form 2.2	Statement of claim—debt or liquidated demand
Court Procedures Rules 2006
(see r 50 (Originating claim—content etc) and r 303 (Third-party notice—content etc))
In the *[Supreme/Magistrates] Court of the Australian Capital Territory

No *[SC/MC]		of (year) (Court to complete)

(name)
Plaintiff

(name)
Defendant

The plaintiff *[claims for a debt/makes a liquidated demand].
Details of the *[claim/demand] are as follows:
•	The amount *[claimed/demanded] is $		.
•	If interest is claimed—details of interest claimed are as follows:
•	Assessed costs *[are/are not] claimed.
(if assessed costs are not claimed)
•	*The amount claimed for costs and disbursements is $		.
*(other material facts relied on in support of claim)

Date:
(signature of plaintiff or plaintiff’s solicitor):
(name of plaintiff or plaintiff’s solicitor)
Notice to defendant
The proceeding on this claim will be stayed (under the Court Procedures Rules 2006, rule 1102 (Stay of debt etc proceeding on payment of amount sought)) if you pay—
•	the amount claimed; and
•	any amount claimed for interest; and 
•	the prescribed costs amount plus any filing and service fees paid.

*omit if, or whichever is, inapplicable