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Get Form 21 Originating Claim

) (Court to complete) *(if proceeding in Magistrates Court, name and provision number of law under which Magistrates Court has jurisdiction to decide claim) (name) Plaintiff (name) Defendant The plaintiff claims against the defendant relying on the facts claimed in the attached statement of claim. Nature of claim (tick appropriate box) debt or liquidated demand motor vehicle death or personal injury employment death or personal injury other death or personal injury other (please.

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