District Court Rules
Schedule: C - Forms in civil proceedings Form: 53A.03 Small Claims Procedure: notice of acceptance of liability
S.I. No. 17 of 2014
53A.03
Small Claims Procedure: notice of acceptance of liability
Schedule C
Order 53A r. 6
AN CHÚIRT DÚICHE
THE DISTRICT COURT
Dublin Metropolitan District/District Court Area of ........ District No. ........
District Court Small Claims Procedure
NOTICE OF ACCEPTANCE OF LIABILITY
CLAIMANT: Name and address of person making the claim ........
RESPONDENT: Name and address of address of person against whom the claim is made ........
I admit the claim made against me in the above matter and
*I agree to pay the amount claimed and enclose herewith applicable cheque/postal order(s) /money orders(s), made payable to the claimant, for the sum of €........ in full settlement.
*I agree to pay the amount claimed and I will refund the full amount to the claimant when the goods are returned by the claimant.
*I consent to judgment being given against me.
*I wish to pay the amount claimed by instalments of €....... per *week/
*month.
Dated this ...... day of ........ 20...
........
Signature of the Respondent
To: the Small Claims Registrar, District Court Office,
at ........
*delete where inapplicable
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