1964_DISTRICT_COURT_CIVIL_PROCEDURE_(FORMS)_RULES — Page 5

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1983 Ed.]

District Court Civil Procedure (Forms) Rules

[CAP.336

D5

[Subsidiary]

FORM 5

WRIT-DEBT OR LIQUIDATED DAMAGES

L.N.183/70. L.N.330/83.

(reverse)

PARTICULARS OF CLAIM

The Plaintiff's claim is for-

and the Plaintiff(s) abandon(s) any excess of his/their claim over $40,000.00 in accordance with the provisions of section 34 of the District Court Ordinance, Chapter 336.

Affidavit of Service.

make oath/do solemnly, sincerely and truly declare and affirm* and say that the within Writ was served by me on the said defendant(s) on the day of 19 by delivering a copy thereof to

Sworn/Affirmed at the Courts of Justice, Victoria/Kowloon/Fanling* District Registry, Hong Kong, the day of 19

Before me,

A Commissioner, &c.

Bailiff's Notes, etc.

* Delete whichever is inapplicable.

原告人之聲請

表格五

L.N.330/83.

訴訟書----欠款或算定賠償

(背頁)

聲請事項

原告人根據香港法例第三三六章地方法院條例第三十四條之規定，對其索償數額中，凡超出四萬元之溢數，俱予放棄。

訴訟書送達宣誓書

本人...誓*/本人經於...年...月...日...將訴訟書送達前述被告人，將該訴訟書一份送交...

執達吏記錄

於維多利亞/九龍/粉嶺*地方法院登記處在本席前宣誓在案

年...月...日

宣誓官

* 不適用之處請予刪去。

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1983 Ed.] District Court Civil Procedure (Forms) Rules [CAP.336 D5 [Subsidiary] FORM 5 WRIT-DEBT OR LIQUIDATED DAMAGES L.N.183/70. L.N.330/83. (reverse) PARTICULARS OF CLAIM The Plaintiff's claim is for- and the Plaintiff(s) abandon(s) any excess of his/their claim over $40,000.00 in accordance with the provisions of section 34 of the District Court Ordinance, Chapter 336. Affidavit of Service. make oath/do solemnly, sincerely and truly declare and affirm* and say that the within Writ was served by me on the said defendant(s) on the day of 19 by delivering a copy thereof to Sworn/Affirmed at the Courts of Justice, Victoria/Kowloon/Fanling* District Registry, Hong Kong, the day of 19 Before me, A Commissioner, &c. Bailiff's Notes, etc. * Delete whichever is inapplicable. 原告人之聲請 表格五 L.N.330/83. 訴訟書----欠款或算定賠償 (背頁) 聲請事項 原告人根據香港法例第三三六章地方法院條例第三十四條之規定，對其索償數額中，凡超出四萬元之溢數，俱予放棄。 訴訟書送達宣誓書 本人...誓*/本人經於...年...月...日...將訴訟書送達前述被告人，將該訴訟書一份送交... 執達吏記錄 於維多利亞/九龍/粉嶺*地方法院登記處在本席前宣誓在案 年...月...日 宣誓官 * 不適用之處請予刪去。 Page 5 Page 6
Baseline (Original)
1983 Ed.] District Court Civil Procedure (Forms) Rules [CAP.336 D5 [Subsidiary] FORM 5 WRIT-DEBT OR LIQUIDATED DAMAGES L.N.183/70. L.N. 330/83. (reverse) PARTICULARS OF CLAIM The Plaintiff's claim is for- and the Plaintiff(s) abandon(s) any excess of his/their claim over $40,000.00 in accord- ance with the provisions of section 34 of the District Court Ordinance, Chapter 336. Affidavit of Service. make oath/do solemnly, sincerely and truly · declare and affirm* and say that the within Writ was served by me on the said defendant(s) on the day of 19 by deliver- ing a copy thereof to Sworn/Affirmed at the Courts of Justice, Victoria/Kowloon/Fanling* District Registry, Hong Kong, the day of 19 Before me, A Commissioner, &c. Bailiff's Notes, etc. • Delete whichever is inapplicable. 原告人之聲請 表格五 L.N. 330/83. 訴訟書----欠款或算定賠償 (背頁) 聲請事項 原告人根據香港法例第三三六章地方法院條例第三十四條之規定,對其索償數 額中,凡超出四萬元之溢數,俱子放棄。 訴訟書送達宣誓書 執達吏記錄 本人 誓*,本人經於 月 發誓/謹以淇誠發 年 B 將訴訟書送達前述被告人,將該訴訟書一份送 交 年 月 日於維多利亞/ 九龍/粉嶺*地方法院登記處在本席前宣誓在 案 * * 不適用之處請予刪去。 宣誓官 Page 5Page 6
2026-05-04 14:11:38 · Baseline
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1983 Ed.]

District Court Civil Procedure (Forms) Rules

[CAP.336

D5

[Subsidiary]

FORM 5

WRIT-DEBT OR LIQUIDATED DAMAGES

L.N.183/70. L.N. 330/83.

(reverse)

PARTICULARS OF CLAIM

The Plaintiff's claim is for-

and the Plaintiff(s) abandon(s) any excess of his/their claim over $40,000.00 in accord- ance with the provisions of section 34 of the District Court Ordinance, Chapter 336.

Affidavit of Service.

make oath/do solemnly, sincerely and truly

· declare and affirm* and say that the within Writ was served by me on the said defendant(s) on the day of

19 by deliver-

ing a copy thereof to

Sworn/Affirmed at the Courts of Justice, Victoria/Kowloon/Fanling* District Registry, Hong Kong, the

day of

19

Before me,

A Commissioner, &c.

Bailiff's Notes, etc.

• Delete whichever is inapplicable.

原告人之聲請

表格五

L.N. 330/83.

訴訟書----欠款或算定賠償

(背頁)

聲請事項

原告人根據香港法例第三三六章地方法院條例第三十四條之規定,對其索償數 額中,凡超出四萬元之溢數,俱子放棄。

訴訟書送達宣誓書

執達吏記錄

本人

誓*,本人經於

月

發誓/謹以淇誠發 年

B

將訴訟書送達前述被告人,將該訴訟書一份送 交

年

月

日於維多利亞/

九龍/粉嶺*地方法院登記處在本席前宣誓在

案

*

* 不適用之處請予刪去。

宣誓官

Page 5Page 6

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