Form 3.50	Small Claims Court—third-party notice
Court Procedures Rules 2006
(see r 3747 (Small Claims Court—third-party notice))
In the Small Claims Court of the Australian Capital Territory

Application No		of (year)

(name)
Applicant

(name)
Respondent

(name)
Third Party
To the Registrar:
General declaration
I make the following third-party claim in the Small Claims Court.  The required information about me, the third party and the third-party claim is set out below and in the attachment.
Respondent
(if the respondent is an individual)
Full name:
*[Home/Business] address:
(if the respondent is a corporation)
Name of body:
*[Australian Company Number/Australian Registered Body Number]:
Address of *[registered office/public officer]:
(if the respondent is represented by another person)
Representative’s full name:
Representative’s address:
How may the respondent be contacted?
Address for service of documents
(set out respondent’s address for service in the ACT)
*Telephone No:
(if represented by a solicitor the following information may be given)
*Document exchange box no:
*Fax:
*Email address:
Third party
(if the third party is an individual)
Third party’s name:
Third party’s *[home/business] address:
(if the third party is a corporation)
Name of body:
*[Australian Company Number/Australian Registered Body Number]:
Address of *[registered office/public officer]:
Date:

(signature of respondent or respondent’s representative)
(name of respondent or respondent’s representative)
*omit if, or whichever is, inapplicable

Claim against third party
The applicant has brought a claim against the respondent, particulars of which are stated in the documents served on you with this notice.
The respondent *[claims against you a contribution or indemnity/claims against you relief as stated in this notice/requires an issue stated in this notice to be decided not only as between the applicant and respondent but also between either of them and you].

Grounds of claim against third-party:
(set out briefly the grounds of the claim against the third party)

*Relief sought:
(set out relief sought)

Date:

(signature of respondent or respondent’s representative)
(name of respondent or respondent’s representative)
*omit if, or whichever is, inapplicable