District Court Area of
District No.
Record number:

*In the matter of ........ Between

........ *Applicant/*Claimant

........ (in the above Court *(area and) district) ........ Respondent

SUMMONS

WHEREAS an application has been made to me by the above *applicant/*claimant on the ...... day of ........ 20.... to sign and issue this summons to you, the above-named respondent, in respect of the following matter claimed by the applicant against you, namely, [insert particulars of the nature of the proceedings or matter at issue, including a summary of any facts relied on and the provisions of any enactment relied on in making the application]

THIS IS TO NOTIFY YOU that the matter will be entered before a sitting of the District Court for the above Court *(area and) district to be held at ........ on the ...... day of ........ 20.... at .......a.m./p.m. AND TO REQUIRE YOU to appear at the said sitting to answer to the said matter.

Dated this ...... day of ........ 20....

at the District Court Office at........

Signed: ........

District Court Clerk assigned to the above Court area.

To ........ of ........

respondent

*Delete where inapplicable