Small Claims Tribunals Amendment Regulations (No. 2) 1992 (WA)

5738   GOVERNMENT GAZETTE, WA [27 November 1992

CONSUMER AFFAIRS

CN301

SMALL CLAIMS TRIBUNALS ACT 1974

SMALL CLAIMS TRIBUNALS AMENDMENT REGULATIONS (No. 2) 1992

Made by His Excellency the Lieutenant-Governor and Administrator in Executive

Council.

Citation
1. These regulations may be cited as the Small Claims Tribunals Amendment

Regulations (No. 2) 1992.

Schedule amended
2. The Schedule to the Small Claims Tribunals Regulations 1975* is amended by

deleting Form 1 and substituting the following form—

SCTForm 1

Form 1 Claim No.

WESTERN AUSTRALIA

SMALL CLAIMS TRIBUNALS ACT 1974 Date Filed

(Section 24)	Fee $
CLAIM FORM	Receipt No.
Officer

I/WE, the claimant(s) named below, give notice that
I/WE wish to refer this claim to a Small Claims Tribunal.

I/WE tender the application fee with this claim.

PLEASE PRINT OR WRITE CLEARLY

1. PERSON(S) MAKING CLAIM [CLAIMANT(S)]

Mr/Mrs/Ms/Miss

Family Name Given Names

Address

Postcode

Thlephone Number: (H) (W)

27 November 19921 GOVERNMENT GAZETTE, WA 5739

2. [RESPONDENT]

TRADER AGAINST WHOM THE CLAIM IS MADE. Address...................................................................................................................

..............................................Postcode ...................

TRADER No. 2 (if any)
FullTrading Name ................................................................................................

Address...................................................................................................................

................................. Postcode ...................

3.    Date of transaction or when problem arose .......................................................

4.    What remedy (Order(s)) are you seeking?

Refund $ .................................	Compensation $ ....................
Relief from Payment	Cost of having work performed by another
$ ...........................................[]	contractor $ ...........................

Other(please state) .........................................$ .........................................
Totalof claim $ ......................................................................................
(Must be less than $6 000)

5.    Has the matter been dealt with by the Ministry of Consumer Affairs?

Yes LII No

If Yes, please quote file number. ..........................................................................

6.    Was the purchase/hiring of goods/supply of services for your own Private use.

Yes LII No [II

7. Has any legal action been taken by either you or the trader

Yes No [11

If Yes, please give details including the name of the court.

8.    Please give full details of your claim (attach additional sheets if needed).

9.   Signature of Claimant(s) ....................................................................................

Date.................................................................................................

A copy of this Claim Form will be sent to the other party. ".

[*Published in the Gazette of 7 March 1975 at pp.	844-7. For amendments to 31 August
1992 see 1991 Index to Legislation of Western Australia, pp.	489-490 and Gazette of
14 August 1992 at p. 4010.1
By His Excellency's Command,

D. G. BLIGHT, Clerk of the Council.