IN THE DISTRICT COURT OF                                 

(Title and number of the action).

I,                                  of                                  hereby make oath and say as follows:

1. I am the plaintiff (or as the case may be) in the above action in which judgment (or order), was given on the                       day of                       , 19            , in my favour for possession of the property hereinafter described, that is to say,                                  .

2. A copy of the said judgment (or order) was served on the defendant personally on the day of                                  , 19            , and the same has not been obeyed.

*3. On the                       day of                       , 19            , I sent by prepaid post to A.B. and C.D., the persons being in actual possession of the said premises or property, a letter setting out the particulars of the said judgment (or order) and asking them to vacate the said premises forthwith (summarise the contents of the letter) and stating that in default of vacating the said premises or of any application by them to the Court for relief or otherwise I would proceed to recover possession upon the said judgment (or order) without further notice.

*4. On the                       day of                       , 19            , I received from A.B. and C.D. the letter(s) which is/are annexed hereto and marked.

5. I am informed and according to the best of my knowledge and information verily believe (state source of information and grounds for belief) that save for the defendant (and) his family and the above-named persons served with notice of these proceedings there is no other person who is in actual possession of the whole or nay part of the said premises and who would be entitled to apply to the Court for relief or otherwise (or as the case may be). I submit that the defendant (and the above-named persons) has/have received sufficient notice of these proceedings to enable him/them to apply to the Court for relief and I crave leave to issue forthwith a writ for recovery of possession of the said premises (and, should a plaintiff so desire, for recovery of the amount due under the said judgment or order).

Sworn, etc.

Note.- The form should be modified to suit the circumstances of each particular case. When the defendant is the only person in possession, no formal notice is required. Where there are other persons (not parties to the proceedings) in actual possession it is necessary to serve them with such written notice as will give them a reasonable opportunity of applying to the Court.