Form
15 (version 2)
UCPR 15.13
UCPR 15.13
STATEMENT OF PARTICULARS
COMPENSATION TO RELATIVES PROCEEDINGS
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COURT DETAILS
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Court
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#Division
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#List
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Registry
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Case number
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TITLE OF PROCEEDINGS
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[First] plaintiff
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[name]
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#Second plaintiff #Number of
plaintiffs (if more than two)
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[First] defendant
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[name]
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#Second defendant #Number of
defendants (if more than two)
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FILING DETAILS
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Filed for
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[name] [role of party eg
plaintiff]
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#Filed in relation to
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[eg
plaintiff's claim, (number) cross-claim]
[include
only if form to be eFiled]
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#Legal representative
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[solicitor on record] [firm]
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#Legal representative reference
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[reference number]
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Contact name and telephone
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[name] [telephone]
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Contact email
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[email address]
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DETAILS OF PERSON[S] ON
WHOSE BEHALF THE PROCEEDINGS ARE COMMENCED
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Name
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Address
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Relationship to deceased
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Marital status
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[repeat
as necessary for each person on whose behalf the proceedings are
commenced]
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SUMMARY OF CLAIM
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DETAILS OF DEPENDENCY ON
DECEASED
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[See
UCPR 15.13(2)(a)(ii).]
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DOCUMENTS SERVED IN SUPPORT
OF CLAIM
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[See
UCPR 15.13(2)(b). Include documents already served in support of the
claim and documents to be served with this statement. You should
include a statement of reasons as to why any document or part of
document which cannot be served with this statement is not served.]
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OTHER DOCUMENTS SERVED
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[See
UCPR 15.13 (2) (c).]
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SIGNATURE
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#Signature
of legal representative
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#Signature
of or on behalf of party if not legally represented
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Capacity
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[eg
solicitor, authorised officer, role of party]
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Date of
signature
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