FORM 49
AN CHÚIRT CHUARDA
THE CIRCUIT COURT
CIRCUIT COUNTY OF
In the matter of *an application *[applications] under section 9(2)(c)of the Health (Repayment Scheme) Act 2006 concerning holders of patients’ private property accounts resident in ..........................................
Take notice that on the ...... day of ......... 20 ..... at ....... o’clock, or as soon thereafter as the applicant will be heard, application will be made by the Health Service Executive to a Judge of the Circuit Court sitting at .......................... for directions, in respect of the patients’ private property accounts of *[certain of] the account holders residing in [specify name(s)and address(es) of hospital(s) or institution(s)concerned] as to how the Health Service Executive may use any money in excess of *€5,000 *[or insert amount prescribed in regulations made under section 20(1)(c) of the Act] in any of those accounts for the benefit of the account holder in whose patient’s private property account the excess is lodged.
[Any person requiring further information concerning this application should contact ....................]
Dated ..................... 20 ....
Signed:
Health Service Executive/Solicitor for the Health Service Executive
*Insert as appropriate
Form 49 inserted by SI 446 of 2007, effective 6 August 2007.