FORM 10
 

AN CHÚIRT CHUARDA
THE CIRCUIT COURT

CIRCUIT                                                                                                            COUNTY OF

 

REQUEST FOR JUDGMENT BY DEFAULT OF DEFENCE

 

BETWEEN

...............……. Plaintiff
AND
.......…………….

The Plaintiff refers to the Civil Bill issued herein on the ........ and served herein on the ................... An Appearance having been entered by the Defendant on the ................, but no Defence having been delivered by the Defendant the Plaintiff hereby requests that judgment be entered for ........... being the sum now actually due over all just credits and allowances (or the goods and chattels withheld by the Defendant) as verified by the affidavit sworn by .................., together with Costs.

 

CERTIFICATE

 

It is hereby certified that the sum of .... only/no sum whatsoever has been paid on foot of the claim herein since service of the Civil Bill herein and that the sum of .... is now actually due by the Defendant to the Plaintiff.
 

Dated the ...... day of ..........

Signed ........…………............... 
Plaintiff/Solicitor for the Plaintiff

To: ................….……..........
The Defendant/Solicitor for the Defendant

and

To: The County Registrar