Western Australian Consolidated Regulations

DISTRICT COURT (FEES) REGULATIONS 2002 - SCHEDULE 3

[r. 4(6), 7(2)]

Form 1
Declaration that a person is a small business or a non‑profit association
In the District Court of Western Australia			No.         of  2
Plaintiff:         ....................................................................................................
Defendant:         .....................................................................................................
Applicant:	........................................................................................... Full name
	........................................................................................... Address
	........................................................................................... Name of small business
	........................................................................................... Position held by applicant in the small business
I declare that the person in respect of which the application is made is a small business  1 or a non‑profit association  2 within the meaning of that term in the District Court (Fees) Regulations 2002 .
Signature of applicant:
Date:
Note:  It is an offence under regulation 4(12) of the  District Court (Fees) Regulations 2002 for a person to make a statement or representation in this declaration that the person knows or has reason to believe is false or misleading in a material particular. The maximum fine is $1 000.
1 Under regulation 3 of the District Court (Fees) Regulations 2002 a small business is —
an individual or individuals in partnership who wholly own and operate a business undertaking that has less than 20 full‑time equivalent employees and partners;
a corporation that has less than 20 full‑time equivalent employees and that is not a subsidiary of a corporation that has 20 or more full‑time equivalent employees;
a company within the meaning of the Companies (Co‑operative) Act 1943 that has less than 20 full‑time equivalent employees and that is not, under section 130(1) of that Act, deemed to be a subsidiary company of another company or corporation that has 20 or more full‑time equivalent employees; or a corporation within the meaning of the Statutory Corporations (Liability of Directors) Act 1996 that has less than 20 full‑time equivalent employees and that is not a body that would be a subsidiary, if the corporation were a corporation to which the Corporations Act 2001 of the Commonwealth applies, of a corporation within the meaning of the Corporations Act 2001 of the Commonwealth or the Statutory Corporations (Liability of Directors) Act 1996 that has 20 or more full‑time equivalent employees.
2 Under regulation 3 of the District Court (Fees) Regulations 2002 a non-profit association is a society, club, institution, or body that is not for the purpose of trading or securing pecuniary profit for its members from its transactions.

        [Form 1 amended in Gazette 30 Dec 2003 p. 5707‑8.]

Form 2 Application to remit fees
In the District Court of Western Australia			No.         of  2
Plaintiff:         ..................................................................................................
Defendant:         ..................................................................................................
Applicant:	........................................................................................ Full name
	........................................................................................ Address
	........................................... Date of birth				........................................ MDL No.
The following reasons are the special reasons for applying to have the fees in relation to the above matter waived/ reduced/ refunded/ deferred*. ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... *         Strike out those that are not applicable.
If the special reasons include that an important right or obligation affecting the community or a significant part of the community will be determined, what is the right or obligation? [Give details of each right or obligation, and explain why it affects the community or a significant part of the community.] ................................................................................................................... ................................................................................................................... ................................................................................................................... ................................................................................................................... ...................................................................................................................
If the special reasons include that the development of the law generally will be affected so as to reduce the need for further litigation, what law will be developed generally? [Give details of how a determination in relation to that law will reduce the need for further litigation.] .................................................................................................................. .................................................................................................................. .................................................................................................................. .................................................................................................................. ..................................................................................................................
If the special reasons include financial hardship the information required in the following part of this form must be provided by the applicant if the applicant is a natural person.
I am employed as a ................................  by ......................................... * Their business address is ........................................................................ *
I am unemployed/ a pensioner* and registered with the Department of Social Security at .......................................................................................
I am single/ married/ separated.*
I have/ do not have* a dependant wife/ husband/de facto partner* and .............. dependant children.
My weekly/ fortnightly* income and expenditure is as follows (in whole dollars) —
Income			Expenditure
Wage/salary/benefit (net)			Rent/board				$
Self		$	Mortgage payment				$
Spouse		$	Maintenance for dependants				$
De facto partner		$	Food				$
Total		$	Electricity/gas				$
Money in bank or other financial institution			Telephone				$
Self		$	Water				$
Spouse		$	Rates and taxes				$
De facto partner		$	Court orders				$
Total		$	Lease or other (give details)				$
Income from investments		$	Other debts owing (give details)				$
Other income		$
Money owed to me		$
TOTAL			TOTAL
ASSETS			VALUE $
My assets and liabilities are as follows —
House or other real property (give addresses)
................................................................................................ ................................................................................................							.............. ..............
TOTAL
Motor vehicles (car, utility, motor cycle, truck, etc.)
Make and model				Reg. No.
TOTAL
Home contents
Television				yes / no
Video recorder				yes / no
Stereo system				yes / no
Furniture				yes / no
Dishwasher				yes / no
Microwave oven				yes / no
Collection of coins, stamps, etc.
Other collectables
Interest in business or company
Other assets
TOTAL
LIABILITIES
Mortgage to ....................................................... for $
Other to ............................................................. for $
Time to pay order ............................................. for $
TOTAL
If the special reasons include financial hardship the information required in the following part of this form must be provided by the applicant if the applicant is a corporation or incorporated association.
INCOME						$
LIABILITIES						$
ASSETS						VALUE $
Signature of applicant:
Date:
*         Strike out words that are not applicable. Note:  It is an offence under regulation 7(4) of the  District Court (Fees) Regulations 2002 for a person to make a statement or representation in this application that the person knows or has reason to believe is false or misleading in a material particular. The maximum fine is $1 000.

        [Form 2 amended in Gazette 30 Jun 2003 p. 2601; 30 Dec 2003 p. 5708‑9; 28 Apr 2005 p. 1757.]

Form 3 Application for determination of dispute about fees
In the District Court of Western Australia		No. of 20
Plaintiff:         ................................................................................................
Defendant:         ................................................................................................
Application:	To the Principal Registrar for a determination under s. 89A(3) of the District Court of Western Australia Act 1969 of a question regarding fees.
Applicant:	...................................................................................... Full name
	...................................................................................... Address
	........................................... Date of birth		...................................... MDL No.
Disputed fee:	The disputed fee is for ................................................. ...................................................................................... ......................................................................................
	Payable under the District Court (Fees) Regulations 2002 Schedule 1 item ..............................
	I dispute — ❑         that the fee is payable ❑         the amount of the fee ❑         other [give details] .................................................         ...........................................................................
I dispute the fee because ............................................................................ ..................................................................................................................... ..................................................................................................................... .....................................................................................................................
Signature of applicant:
Date:	/ /20

        [Form 3 inserted in Gazette 28 Apr 2005 p. 1757.]