Western Australian Consolidated Regulations

DISTRICT COURT RULES 2005 - SCHEDULE 1

[r. 3]

1A .         Affidavit (r. 23A)

District Court of Western Australia		Appeal No:
		Affidavit 1
Parties
Person making affidavit
Date made
Purpose 2
Filed by	[ Party ]
Index 3	Contents		Page
	1.         Affidavit of Vincent van Gogh 2.         Attachment VVG 1–M J Citizen’s birth certificate 3.         Attachment VVG 2–Letter from J Smith to T Jones dated 3 March 1999		1 7 8

Page 1 4 I, [ name, address and occupation of person making the affidavit ], [ insert words of oath or affirmation in accordance with the Oaths, Affidavits and Statutory Declarations Act 2005] as follows — 1.         [ insert content of affidavit in numbered paragraphs ] 2. This affidavit is [ sworn/affirmed ] by [ name of person making the affidavit ] in the presence of an authorised witness at [ place ] on [ date ]. [ Signature of person making the affidavit ] [ Signature of authorised witness ] Authorised witness [ Name of authorised witness ] [ Qualification of authorised witness ] 5

Notes to Form 1A —
1.         The affidavit must comply with the RSC Order 37.
2.         Example: To support summons by plaintiff dated 1 May 2010 for summary judgment.
3.         The index must comply with the RSC Order 37 rule 2(7). Form 1A contains in italics an example of an index.
4.         Page 1 must be on a separate sheet of paper from the above.
5.         The Oaths, Affidavits and Statutory Declarations Act 2005 Part 3 sets out the requirements for affidavits and who are authorised witnesses for affidavits.

        [Form 1A inserted in Gazette 17 Jun 2011 p. 2156.]

1 .         Entry for trial (r. 37)

District Court of Western Australia Entry for trial			At: Number:
Matter	[ Names of all parties ]
Certificate * delete if inapplicable	The [ party ] certifies that —               •         the [ party ] has been given discovery and inspection by all of the other parties; and               •         *the [ party ] served interrogatories and has received answers; and               •         the [ party ] has complied with all directions and orders made by the Court at the case management hearing; and               •         the [ party ] has complied with all orders made by the Court since the case management hearing; and               •         no other interlocutory orders are needed; and               •         the [ party ] has complied with the Rules of the Supreme Court 1971 Order 36A; and               •         the [ party ] has complied with the District Court Rules 2005 rule 36(1); and               •         the [ party ] has complied with the District Court Rules 2005 rule 45C; and               •         *the [ party ] has complied with the District Court Rules 2005 rule 45D; and               •         this matter is in all respects ready for trial.
Entry for trial	The [ party ] enters this matter for trial.
Unavailable dates	The parties are not available for a pre‑trial conference on these dates:
Contact details of party or lawyer	Name
	Firm
	Address
	Phone		Fax
	Email
	Reference
Signature of party or lawyer	Party/[ Party’s ] lawyer				Date

        [Form 1 inserted in Gazette 10 Dec 2010 p. 6267‑8; amended in Gazette 18 Nov 2011 p. 4815.]

2 .         Notice of default (entry for trial) (r. 38)

District Court of Western Australia Notice of default (entry for trial)		At: Number:
Matter	[ Names of all parties ]
Notice to all parties	The plaintiff has not entered this action for trial as required. Unless the plaintiff enters this action for trial on or before [ date ], this action will become inactive. Despite the above, any party other than the plaintiff may now enter this action for trial, and may do so even if the action has become inactive.
Seal of Court			Date:

3 .         Outline of submissions (r. 45H, 61)

District Court of Western Australia Outline of submissions		At: Number:
Matter	[ Names of all parties ]
Party filing outline	[ Name of party filing outline and whether plaintiff or defendant, appellant or respondent ]
Notice *Delete if inapplicable	Attached to this form are these documents in this order — •         Submissions; and •         Legal authorities; and •         *List of orders wanted; and •         *Draft chronology.
Signature of party or lawyer	Party/[ Party’s ] lawyer		Date:

        [Form 3 inserted in Gazette 31 Jul 2007 p. 3822.]

4 .         Prohibited Behaviour Orders Act 2010 s. 5 application (r. 71B)

District Court of Western Australia Prohibited Behaviour Orders Act 2010 s. 5		No:
		Application for prohibited behaviour order. Hearing notice
Applicant
Respondent
Application	The applicant applies under the Prohibited Behaviour Orders Act 2010 section 5 for a prohibited behaviour order (PBO) against the respondent.
Proposed PBO	The applicant applies for the following constraints in the PBO against the respondent — 1. The applicant applies for the PBO for a period of [ state period ]. 1
Signature of applicant or lawyer	Applicant/Applicant’s lawyer		Date:
Hearing details 2	This application will be heard at this date, time and place — Date:         Time: Place:		Court seal:

Notes to Form 4 —
1.         The period stated here must comply with the Prohibited Behaviour Orders Act 2010 s. 12.
2.         The Court will complete this row when the application is submitted.

        [Form 4 inserted in Gazette 17 Jun 2011 p. 2156‑7.]

5 .         Prohibited Behaviour Orders Act 2010 s. 21 application (r. 71C)

District Court of Western Australia Prohibited Behaviour Orders Act 2010 s. 21		No:
		Application to vary or cancel prohibited behaviour order. Hearing notice
PBO’s details	Date made: Constrained person:
Applicant
Respondent
Application	The applicant applies under the Prohibited Behaviour Orders Act 2010 section 21 to 1  vary/cancel the above PBO (prohibited behaviour order).
Variation(s) wanted 2	1.
Grounds for application  3	1.
Signature of applicant or lawyer	Applicant/Applicant’s lawyer		Date:
Hearing details 4	This application will be heard at this date, time and place — Date:         Time: Place:		Court seal:

Notes to Form 5 —
1.         Delete the inapplicable.
2.         Omit this row if the application is to cancel a PBO.
3.         Set out the grounds in numbered paragraphs.
4.         The Court will complete this row when the application is filed.

        [Form 5 inserted in Gazette 17 Jun 2011 p. 2157.]

6 .         Appeal notice (r. 51(1))

District Court of Western Australia		Appeal No:
		Appeal notice
Parties	Appellant                                 Respondent
Primary court’s decision
Primary court Case number Parties Date of decision Judicial officer
Decision details 1
Appeal details
Notice of appeal	The appellant appeals to the District Court against the above decision.
Grounds of appeal  2	1.
Acts that allows appeal 3	section:
Notice to the respondent 4	If you want to take part in this appeal you must file a Form 8 (attached) under the District Court Rules 2005 within 21 days after the date on which you are served with this notice and serve it on the appellant. If you file a Form 8 you must attend a directions hearing at the time and place stated below.
Last date for appealing	Last date: Is an extension of time needed? Yes/No
Date of filing
Directions hearing  5	Date:                                 Time: Place:
Appellant’s details for service 6
Name Street address Telephone Email address Reference No.	Fax No.
Signature of appellant or lawyer	Appellant/Appellant’s lawyer		Date:

Notes to Form 6 —
1.         Examples:
•         Judgment against the defendant for $40 000.
•         Dismissal of claim to recover possession of real property.
2.         Set out the grounds in numbered paragraphs.
3.         State the short title of the Act under which the appeal is being made.
4.         A copy of Form 8 (Notice of respondent’s intention) must be attached to this form when it is served on the respondent.
5.         The Court will complete this row when the appeal notice is filed.
6.         If the appellant is represented by a lawyer, the appellant’s details below must be the lawyer’s. If the appellant is self‑represented, the details must be the appellant’s personal details.

        [Form 6 inserted in Gazette 17 Jun 2011 p. 2165‑6; amended in Gazette 18 Nov 2011 p. 4815.]

7 .         Service certificate (r. 51(7))

District Court of Western Australia		Appeal No:
		Service certificate
Parties	Appellant                                 Respondent
Certificate 1	I certify that on [ date ] at [ place ] [ name of server ] served the respondent personally with these documents — ●         a copy of an appeal notice dated [ date ]/appeal notice (WCIMA appeal) dated [ date ] 2 ; ●         a copy of every other document that was filed with the appeal notice; ●         a copy of Form 8 (Notice of respondent’s intention). I undertake to file an affidavit of service if the Court requires me to.
Signature of appellant or lawyer	Appellant/Appellant’s lawyer		Date:

Note to Form 7 —
1.         If the documents were posted to the superintendent of the prison in which the respondent is imprisoned, modify this certificate to say when they were posted and to which prison.
2.         Strike out whichever is inapplicable.

        [Form 7 inserted in Gazette 17 Jun 2011 p. 2166; amended in Gazette 18 Nov 2011 p. 4815.]

8A .         Appeal notice (WCIMA appeal) (r. 51(4A))

District Court of Western Australia		Appeal No:
		Appeal notice (WCIMA appeal)
Parties	Appellant         Respondent
Primary court’s decision
Primary court Case number Parties Date of decision Arbitrator	WorkCover WA Arbitration Service
Decision details 1
Appeal details
Notice of appeal	The appellant applies for leave to appeal to the District Court against the above decision.
Act that allows appeal	Workers’ Compensation and Injury Management Act 1981 ( WCIMA ) section 247.
Question of law 2
Amount in issue 3
Grounds of appeal  4	1.
Decision sought  5	1.
Leave	The appellant applies for leave to appeal under WCIMA section 247 on the ground that: 6
Other orders	The appellant also seeks orders that: 7
Notice to the respondent 8	If you want to take part in this appeal you must file a Form 8 (attached) under the District Court Rules 2005 within 21 days after the date on which you are served with this notice and serve it on the appellant. If you file a Form 8 you must attend a directions hearing at the time and place stated below.
Last date for appealing	Last date:
Date of filing
Directions hearing  9	Date:                 Time: Place:
Appellant’s details for service 10
Name Street address Telephone Email address Reference No.	Fax No.:
Signature of appellant or lawyer	Appellant/Appellant’s lawyer		Date:

Notes to Form 8A —
1.         Examples:
•         Determination of liability in favour of the respondent.
•         Dismissal of application seeking determination of liability.
•         Orders for cessation/reduction of weekly payments.
•         Orders for recovery of payments made.
2.         Specify question(s) of law the subject of the appeal.
3.         This is the amount that will be used to determine whether leave is able to be granted under WCIMA section 247.
4.         Set out the grounds in numbered paragraphs.
5.         See rule 51(4B)(c).
6.         Specify subsection(s) under which the application is made. The grounds for leave should be in numbered paragraphs.
7.         For example, to adduce fresh or further evidence under WCIMA section 247(6) or a stay under section 250(1).
8.         A copy of Form 8 (Notice of respondent’s intention) must be attached to this form when it is served on the respondent.
9.         The Court will complete this row when the appeal notice (WCIMA appeal) is filed.
10.         If the appellant is represented by a lawyer, the appellant’s details below must be the lawyer’s. If the appellant is self‑represented, the details must be the appellant’s personal details.

        [Form 8A inserted in Gazette 18 Nov 2011 p. 4816-17.]

8 .         Notice of respondent’s intention (r. 53)

District Court of Western Australia		Appeal No:
		Notice of respondent’s intention
Parties	Appellant                                 Respondent
Notice [Tick one box]	ρ 1         The respondent intends to take part in this appeal. ρ 2         The respondent does not intend to take part in this appeal and will accept any order made by the Court in the appeal other than as to costs.
Grounds for upholding	ρ         The respondent will argue the primary court’s decision should be upheld on the grounds relied on by the primary court in its decision.
Other grounds for upholding 3	ρ         The respondent will argue the primary court’s decision should be upheld on the following grounds, not relied on by the primary court in its decision — 1.
Variation 3	ρ         The respondent applies for the primary court’s decision to be varied as follows — 1.         The respondent will argue the primary court’s decision should be varied on the following grounds — 1.
Cross‑appeal 3	ρ         The respondent also appeals against the primary court’s decision and will rely on the following grounds — 1.
Other orders	The respondent also seeks order that:  4A
Last date for appealing 4	Last date: Is an extension of time needed? Yes/No
Respondent’s details for service 5
Name Street address Telephone Email address Reference No.	Fax No.
Signature of respondent or lawyer	Respondent/Respondent’s lawyer		Date:

Notes to Form 8 —
1.         If this box is ticked, complete one or more of the next 5 rows and the respondent’s details for service.
2.         If this box is ticked, ignore the next 5 rows and complete the respondent’s details for service.
3.         Set out the grounds in numbered paragraphs.
4A.         For possible orders see rule 57(2).
4.         Complete this only if the respondent also appeals against the primary court’s decision.
5.         If the respondent is represented by a lawyer, the respondent’s details below must be the lawyer’s. If the respondent is self‑represented, the details must be the respondent’s personal details.

        [Form 8 inserted in Gazette 17 Jun 2011 p. 2166‑7; amended in Gazette 18 Nov 2011 p. 4817-18.]

9 .         Application in an appeal (r. 58A)

District Court of Western Australia		Appeal No:
		Application in an appeal
Parties	Appellant                         Respondent
Applicant	Appellant/Respondent
Application 1	The applicant applies for —
Conference between parties [Tick one box]	ρ         The parties to this application have conferred about the issues giving rise to this application and have not resolved them. ρ         The parties to this application have not conferred about the issues giving rise to this application because —         2
Signature of applicant or lawyer	Applicant/Applicant’s lawyer		Date:

Notes to Form 9 —
1.         State —
•         the order or orders sought; and
•         the written law and provision under which the application is made.
2.         State the reasons why the parties have not conferred.

        [Form 9 inserted in Gazette 17 Jun 2011 p. 2167‑8.]

10 .         Consent notice (r. 58B)

District Court of Western Australia		Appeal No:
		Consent notice
Parties	Appellant                         Respondent
Consent	We consent to the following order being made —
Signature of appellant or lawyer	Appellant/Appellant’s lawyer		Date:
Signature of respondent or lawyer	Respondent/Respondent’s lawyer		Date:

        [Form 10 inserted in Gazette 17 Jun 2011 p. 2168.]

11 .         Discontinuance notice (r. 58)

District Court of Western Australia		Appeal No:
		Discontinuance notice
Parties	Appellant                         Respondent
Notice	The appellant discontinues this appeal.
Signature of appellant or lawyer	Appellant/Appellant’s lawyer		Date:

        [Form 11 inserted in Gazette 17 Jun 2011 p. 2168.]