Form 3.52	Small Claims Court—acceptance of admission of liability
Court Procedures Rules 2006
(see r 3754 (Small Claims Court—admission of liability))
In the Small Claims Court of the Australian Capital Territory

Application No		of (year)

(name)
Applicant

(name)
Respondent

To the Registrar:
I accept the terms on which the respondent has admitted liability in full satisfaction of my claim.
Date:
(signature of applicant or applicant’s representative)
(name of applicant or applicant’s representative)