CLAIM FORM

I17/6/2020)

Form I [Rule8.1(3)]

IN THE SUPREME COURT OF JUDICATURE OF JAMAICA

CLAIM NO

BETWEEN CLAIMANT
AND DEFENDANT

The Claimant, A.B. (full name and if an individual, state occupation) of (full address) claims against the
Defendant, C.D. (full name) of (full address)
(Insert brief details of the nature of the claim and state any specific remedy that you are seeking.)

The following is to be completed only where the claim is for a specific sum)

$
Amount claimed
Together with interest from to date
(Daily rate since today=$ per day
Court Fees
Attorney's Fixed Costs on issues
Total Amount claimed

I [name] certify that I believe the facts stated in this [name of document] are true.

Dated the day of 20

Claimant's Signature

321