Supreme Court Rules 1937—Form 1.3
(see o 2 r 11)
Claim for debt or liquidated demand statement to accompany originating application
In the Supreme Court of the Australian Capital Territory

No		of (year)

(name/s)
Plaintiff[s]*

(name/s)
Defendant[s]*
In an originating application dated [date], the plaintiff claims for debt*/makes a liquidated demand* as follows:
•	The amount claimed is $		.
•	If interest is claimed—details of interest claimed are as follows:1
•	Taxed costs [are* / are not*] claimed.
•	If taxed costs are not claimed—
the amount claimed for costs and disbursements is $	.*
Notice to defendant
Proceedings on this claim will be stayed (under order 3 of the Supreme Court Rules 1937) if you pay—
•	the amount claimed; and
•	any amount allowed for interest and costs. 
Date:
Signature of plaintiff*/plaintiff’s solicitor*:
*Strike out where inapplicable.
Note 1	See the Supreme Court Rules 1937, order 2 rule 11 (1) (b).

Endnotes
1	This form was originally in the Supreme Court Rules 1937. Under the Court Procedures Act 2004 A2004-59, pt 8, the form became a form approved under that Act. 

©  Australian Capital Territory 2005