In the District Court of

No.                       .

Between

A. B.,

Plaintiff,

and

C. D.,

Defendant.

To C.D., of (a)                                  , (b)

This is to command you to appear before the Court at (c)                                  on (Mon)day the                       day of                                  19            , at the hour of            in the forenoon, for the hearing of an action against you by A.B. of (a)                                  (d)                                  .

The Plaintiff's claim in the action is set out in the statement of claim overleaf.

The Plaintiff's address for service is (e)                                 

And take notice that, in default of your appearing before the Court on the day aforesaid, the Plaintiff may proceed in the action and judgment may be given in your absence.

And take notice further that if you intend to dispute the Plaintiff's claim you must, within ten days after service of the writ of summons deliver your defence in writing to the Plaintiff himself or at his address for service and give a duplicate thereof or send the same by registered post to the registrar of the Court at (f)                                 

Filed and sealed on the (g)                                  day
of                                  , 19           

(Signed)                                 

Registrar.                      

(a) Give full address, including street and number of premises, if any.

(b) State Defendant's occupation, if known.

(c) State the town or village in which the Court will hear the action.

(d) State Plaintiff's occupation.

(e) Give the full name, occupation, and address of a person within the municipal limits of the town or village in which is situated the Registry in which the action is filed, with whom documents intended for Plaintiff may be left. The town or village meant is that stated in the writ of summons at the end thereof, against the letter(f).

(f) State the town or village in the Registry of which the action is filed.

(g) The date should be filled in by the Registrar.

(N.B.-In drawing up a writ regard should be had to the provisions governing statements of claim.