District Court Rules
Schedule: C - Forms in civil proceedings Form: 40A.04 Verifying affidavit
S.I. No. 17 of 2014
40A.04
Verifying affidavit
Schedule C
O.40A, r.8
District Court Area of
District No.
Record number:
Between
........ Claimant
........ Respondent
VERIFYING AFFIDAVIT
Civil Liability and Courts Act 2004, section 14
[The title need not be repeated where the affidavit is endorsed on the pleading or other document]
I, ........ of ........ , the (claimant, respondent or identify the capacity in which the affidavit is made) in the above proceedings, aged eighteen years and upwards MAKE OATH and say as follows:
1. I beg to refer to the contents of the (personal injuries summons, defence, reply, further information etc. — as the case may be) delivered herein on behalf of the (claimant/ respondent) on the ...... day of ........ 20.... *[upon which this affidavit is endorsed] *[and upon a true copy of which marked “AB1” I have signed my name prior to the swearing hereof].
2. The assertions, allegations and information contained in the said (personal injuries summons, etc.) which are within my own knowledge are true. I honestly believe that the assertions, allegations and information contained in the said (personal injuries summons, etc.) which are not within my own knowledge are true.
3. I am aware that it is an offence to make a statement in this affidavit that is false or misleading in any material respect and that I know to be false or misleading.
SWORN before me [name in capitals]
at........
in the County on the ...... day of ........ 20....,
by the said ........
*[who is personally known to me]
*[who is identified to me by ........ who is personally known to me]
*[whose identity has been established to me before the taking of this affidavit by the production to me of
†passport no. ........ issued on the ........ day of........ by the authorities of ........ , which is an authority recognised by the Irish Government
†national identity card no........ issued on the ........ day of........ by the authorities of ........ which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA Agreement
†Aliens Passport no. ........ issued on the ........ day of........ by the authorities of ........ which is an authority recognised by the Irish Government
†refugee travel document no. ........ issued on the ........ day of........ by the Minister for Justice and Equality
† travel document (other than refugee travel document) ........ issued on the ........ day of........ by the Minister for Justice and Equality
................
Deponent
*Commissioner for Oaths/ *Practising Solicitor
*Delete if inapplicable
†Where relevant, select appropriate option and delete others.
This affidavit is filed with the District Court Clerk at........ on the ...... day of ........ 20.... by ........ on behalf of the........ in the above proceedings.
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