Form 2 CLAIM Court Use Magistrates Court of South Australia (Civil Division) Date Filed Date of Posting PI MVA Served Allianz: – Trial Court Action No Street Telephone Facsimile DX Address City/Town/Suburb State Postcode Email Address Amount Claimed (if any) $ Court Fee on Filing $ Service and Other Fee $ Fee $ Solicitor’s TOTAL CLAIMED $ Type of claim (tick) Building Contract Corporations Law Criminal Assets Confiscation Debt Equity Motor Vehicle Property Personal Injury Motor Vehicle Other Personal Injury Retail and Commercial Lease Workers Lien Debt Tribunal Order – Detinue Construction Contract Payment Other (specify) This claim is liquidated unliquidated Method of service (tick) Registrar Sheriff Party Plaintiff’s Solicitor Plaintiff/s Full Name Address Street Telephone Facsimile DX (Registered Office, if Body Corporate) City/Town/Suburb State Postcode Email Address Solicitor for Plaintiff/s (name) Street Telephone Facsimile DX Address City/Town/Suburb State Postcode Email Address Defendant/s Full Name Address Street Telephone Facsimile DX (Registered Office, if Body Corporate) City/Town/Suburb State Postcode Email Address Solicitor for Defendant/s (name) Address Street Telephone Facsimile DX
Form 2 CLAIM Magistrates Court of South Australia (Civil Division) Court Use Date Filed Date of Posting PI MVA – Served Allianz: Trial Court Action No Address Street Telephone Facsimile DX City/Town/Suburb State Postcode Email Address Amount Claimed (if any) $ Court Fee on Filing $ Service and Other Fee $ Solicitor’s Fee $ TOTAL CLAIMED $ Type of claim (tick) Building Contract Corporations Law Criminal Assets Confiscation Debt Equity Motor Vehicle Property Personal Injury Motor Vehicle Other Personal Injury Retail and Commercial Lease Workers Lien Debt – Tribunal Order Detinue Construction Contract Payment Other (specify) This claim is liquidated unliquidated Method of service (tick) Registrar Sheriff Plaintiff’s Solicitor Party Plaintiff/s Full Name Address (Registered Office, if Body Corporate) Street Telephone Facsimile DX City/Town/Suburb State Postcode Email Address Solicitor for Plaintiff/s (name) Address Street Telephone Facsimile DX City/Town/Suburb State Postcode Email Address Defendant/s Full Name Address (Registered Office, if Body Corporate) Street Telephone Facsimile DX City/Town/Suburb State Postcode Email Address Solicitor for Defendant/s (name) Address Street Telephone Facsimile DX