Form 6.21	Request for service abroad of judicial documents and certificate
Court Procedures Rules 2006
(see r 6553 (Application for request for service abroad), r 6555 (Procedure on receipt of certificate of service), r 6562 (Application—subdiv 6.8.12.4) and r 6565 (Affidavit about service))

Part 1		Request for service abroad of judicial documents 

Convention on the Service Abroad of Judicial and Extrajudicial Documents in Civil or Commercial Matters, done at The Hague, 15 November 1965

(identity and address of the forwarding authority requesting service)	(identity and address of receiving authority (Central Authority/additional authority))	

The undersigned forwarding authority (on the application of (name and address of applicant on whose behalf forwarding authority requests service)) has the honour to transmit in duplicate the documents listed below and, in conformity with the Hague Convention, article 5, requests prompt service of 1 copy of the documents on the addressee: 
(identity and address of addressee)
*(a)	in accordance with the Convention, article 5, 1st paragraph, subparagraph (a).
*(b)	in accordance with the following particular method (Convention, article 5, 1st paragraph, subparagraph (b)). 
*(c)	by delivery to the addressee, if the addressee accepts it voluntarily (Convention, article 5, 2nd paragraph).
The receiving authority (Central Authority/additional authority) is requested to return or to have returned to the forwarding authority a copy of the documents *[and of the annexes] with a certificate as provided in part 2 (Certificate of service).
List of documents

Done at (place)
Date:
(signature of forwarding authority)
(name of forwarding authority)
*omit if, or whichever is, inapplicable

Part 2		Certificate of service

Convention on the Service Abroad of Judicial and Extrajudicial Documents in Civil or Commercial Matters, done at The Hague, 15 November 1965

The undersigned forwarding authority has the honour to certify, in conformity with the Hague Convention, article 6: 
*1	that the documents listed in part 1 have been served on (date) at (place, street, number) in 1 of the following methods authorised by the Convention, article 5:
*(a)	in accordance with the Convention, article 5, 1st paragraph, subparagraph (a) (set out the method).
*(b)	in accordance with the following particular method (set out the method). 
*(c)	by delivery to the addressee, who accepted it voluntarily. 
	The documents referred to in the request have been delivered to:
	(identity and description of person)
	(relationship to the addressee (family, business or other))
*2	that the documents listed in part 1 have not been served, because of the following facts: (set out the reasons for non-service).
In conformity with the Convention, article 12, 2nd paragraph, forwarding authority is requested to pay or reimburse the expenses set out in the attached statement.
Annexes
Documents returned: (list documents)
In appropriate cases, documents establishing the service: (list the documents)
Done at (place)
Date:
(signature of forwarding authority)
(name of forwarding authority)
*omit if, or whichever is, inapplicable