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MAGISTRATES COURT GENERAL CIVIL PROCEDURE RULES 2010 Rule 5. 02 1 FORM 5A COMPLAINT IN THE MAGISTRATES COURT OF VICTORIA AT Court Number BETWEEN Plaintiff OF And Defendant Date of Document Filed on behalf of Australian lawyer name Address Code Telephone Reference The address for service of the plaintiff is address must be within Victoria if the plaintiff sues in person Name and address of the Australian lawyer for the plaintiff The Plaintiff sues or the defendant is sued in the following representative capacity eg. As administrator of the estate of STATEMENT OF CLAIM Here set out in numbered consecutive paragraphs all the material facts relied on for the claim against the defendant including particulars of every fact or matter. If the claim arises by or under any Act identify the specific provisions relied on* State specifically the amount or other relief or remedy sought. State the place where and the date when the claim arose. loss of the vehicle an itemised quotation of the costs of the repairs or an assessment of the loss whichever is relevant must be attached to this complaint* TO THE DEFENDANT TAKE NOTICE that this complaint has been brought against you by the plaintiff as set out in the statement of claim* IF YOU INTEND TO DEFEND this complaint YOU MUST GIVE NOTICE OF DEFENCE within 21 days of service upon you of this complaint to a the plaintiff and b the registrar of the Magistrates Court of Victoria at insert proper venue IF YOU GIVE NOTICE OF DEFENCE the Court will write to you and tell you of the hearing date. IF YOU DO NOT GIVE NOTICE OF DEFENCE WITHIN 21 DAYS OF SERVICE the plaintiff may OBTAIN AN ORDER AGAINST YOU for the amount of claim and costs without further notice. IF YOU PAY the amount of and costs of to the plaintiff or the plaintiff s DATE OF FILING THIS COMPLAINT IS VALID IF IT BEARS THE ALLOCATED COURT NUMBER AND THE Dated To be signed by the Plaintiff or the Plaintiff s Australian Lawyer. As administrator of the estate of STATEMENT OF CLAIM Here set out in numbered consecutive paragraphs all the material facts relied on for the claim against the defendant including particulars of every fact or matter. If the claim arises by or under any Act identify the specific provisions relied on* State specifically the amount or other relief or remedy sought. If the claim arises by or under any Act identify the specific provisions relied on* State specifically the amount or other relief or remedy sought. State the place where and the date when the claim arose. loss of the vehicle an itemised quotation of the costs of the repairs or an assessment of the loss whichever is relevant must be attached to this complaint* TO THE DEFENDANT TAKE NOTICE that this complaint has been brought against you by the plaintiff as set out in the statement of claim* IF YOU INTEND TO DEFEND this complaint YOU MUST GIVE NOTICE OF DEFENCE within 21 days of service upon you of this complaint to a the plaintiff and b the registrar of the Magistrates Court of Victoria at insert proper venue IF YOU GIVE NOTICE OF DEFENCE the Court will write to you and tell you of the hearing date. .

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