rr 7.12(4), 7.16(1)
To the Registrar of the District Court at [place]
The applicant, [name, place of residence, occupation], applies for an order/orders* [specify orders sought, numbering them if more than 1].
The grounds on which each order is sought are as follows: [specify concisely the grounds on which each order is sought]/set out in the accompanying memorandum*.
The application is made in reliance on [specify any particular provision of an enactment, principle of law, or judicial decision relied on].
The application is made without notice to any other party on the following ground(s):*
that requiring the applicant to proceed on notice would cause undue delay or prejudice to the applicant:
that the application affects only the applicant:
that the application relates to a routine matter:
that an enactment expressly permits the application to be made without serving notice of the application:
that the interests of justice require the application to be determined without serving notice of the application.
I certify that—
the grounds set out in paragraph 4 on which the application relies are made out; and
all reasonable inquiries and all reasonable steps have been made or taken to ensure that the application contains all relevant information, including any opposition or defence that might be relied on by any other party, or any facts that would support the position of any other party.
Date:
Signature:
(applicant or solicitor/counsel* for applicant)
Phone number:
Schedule 2 form 18: replaced, on 1 August 2019, by rule 5 of the District Court Amendment Rules 2019 (LI 2019/151).