Property qualification.

(A) Ownership of premises.

(1) Description of premises.

(State house number and street name).

(ii) Amount of assessed rates.

(iii) Quarter for which rates

last paid.

(iv) Date of commencement of

ownership.

(v) Whether sole or joint

owner.

(B) Tenancy of premises.

(i) Dascription of premises.

(State house number and street name).

(ii) Amount of assessed rates.

(iii) Quarter for which rates

last paid.

(iv) Date of commencement of

tenancy.

(v) Premises occupied.

(State whether whole premises occupied or

ground floor occupied for business purposes).

(vi) Whether sole or joint tenant

of premises in respect of which claim is made.

Jury Service.

1. Whether name on current Jury List.

2. If name on previous Jury List,

state year and reason for removal of name from list.

Personal qualification claim as

alternative to liability for jury service.

(See section 7(1)(b) to (k)

a copy of which should be

furnished with application form).

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