PARTICULARS OF DEMAND.

The plaintiffs claim £400 damages for the death of G. B., who was killed on the 19 by falling from a scaffold while

day of

working for the defendant as a stonemason, at

The said scaffold formed part of the plant used by the defendant in his business, and was defective owing to the negligence of the defendant's foreman, E. F., who was intrusted by the defendant with the duty of seeing that the plant was in proper condition.

This action is brought by the said plaintiff A. B., as executrix of the last will of the said G. B. deceased, for the benefit of herself as the wife of the said G. B. deceased and by the plaintiffs D. B., E. B., and F. B. (by the said A. B. as next friend), for their benefit, as the children of the said G. B., deceased,

Dated

day of

1. A. B. was, on the

(Signed by solicitor)

Or,
(Heading.)
day of

19

in the

lawfully engaged Dock, under

upon the defendants' work on the ss. a contract of service made with the said defendants, and was on such day killed owing to the defective condition of a portion of the works, machinery, or plant in use by the defendants, to wit, the chain used for raising a propellor, which chain was worn and defective, of insufficient strength and size, and unfit for the said purpose, and broke and caused the said propeller to fall on the said A. B. Such defective condition arose, or had not been discerned or remedied owing to the negligence of the defendants or their foreman, C. D., or other servants intrusted with the duty of seeing that the said works, machinery or plant were in proper condition.

2. Alternatively the said A. B. was killed owing to the negligence of the defendants or their said foreman, or other of their servants, in ordering or allowing the said propeller to be raised by the said chain, or owing to the negligence of the defendants' servants intrusted with superintendence, or to whose orders he was bound to conform.

3. The plaintiff states, pursuant to statute 9 & 10 Vict. c. 93, that she is the widow of the said A. B., who died as above set out whilst in defendants' employ, and that she was entirely dependent upon the said A. B. for her support, and has sustained pecuniary loss from his death.

The plaintiff claims £320.
Dated, etc.

(Signed)

Or,
(Heading.)

The plaintiff claims £100 under the Employers' Liability Act, 1880, and Lord Campbell's Act for the death of his daughter, A. B., which occurred from injuries sustained while the said A. B. was in the service of the defendants. The said death was caused by reason of the negligence of C. D., a person in the service of the defendants, who

had superintendence intrusted to him, whilst in the exercise of such superintendence.

And by reason of a defect in the machinery used by the defendants, and in consequence of the defendants' negligence. Alternatively the plaintiff claims £50 damages under Lord Campbell's Act for the death of the said A. B., the said death having been caused by the negligence and breach of statutory duty of the defendants. Dated, etc.

(Signed)

INTERROGATORIES on behalf of the above-named plaintiff, A. B., for the examination of the above-named defendant, C. D.

1. Was not the plaintiff in your employment on the

19 ?

day of

2. Was not the plaintiff injured on such day by the breaking of, etc., or how otherwise?

entrusted by

3. Do you personally see to and superintend the condition of your ways, works, machinery, and plant? If not, set out the name and description of the person to whom you have entrusted this duty. 4. Was not the plaintiff working under the superintendence of at the time of the accident, and was not the said you with superintendence over the plaintiff? If not, under whose superintendence was the plaintiff working at the time of the accident? 5. Was not the plaintiff bound to conform to the orders or directions also a workman in your employment?

of

6. As regards the plant, which the plaintiff alleges in his particulars of demand in this action was defective, who was responsible for seeing that it was kept in proper condition?

7. Did you receive a report concerning the plaintiff's accident from any one? Was such report verbal or in writing? If verbal, set out the same fully; if in writing, set it out sufficiently for subsequent identification.

8. Where did you obtain the machine (or plant) which broke and injured the plaintiff? How long had you been in possession of it? Had it been repaired? If yea, when and by whom?

9. Do you allege that the plaintiff was guilty of any negligence contributing to his own injury? If yea, set out fully in what respects you allege the plaintiff to have been negligent.

the

day of

10. Did you not receive a registered letter (or a letter) on or about 19 sent by or on behalf of the plaintiff, giving you notice of his injury? Have you this letter in your possession? If not, what has become of it?

(x) These interrogatories are only intended as samples of the kind of questions often asked in these actions.

APPENDIX F.

Form of Affidavit to obtain a writ of Certiorari to remove a case from a County Court.

In the High Court of Justice,

(King's Bench Division). I, A. B., of

1. On last i

make oath and say as follows:

was served with a summons which appeared to me to have been issued out of the County Court of holden at

of which the following is a copy [here copy the summons, or say, a copy of which summons is hereto annexed marked A." and annex a copy].

2. The following is a copy of the particulars of demand annexed to the said summons [here copy particulars, or instead of this say, "2. The paper writing hereto annexed, marked B., is a copy of the particulars of demand annexed to the said summons," and annex a copy.

3. I am the person mentioned and referred to by the name of A. B. in the said summons and particulars.

4. I am advised and verily believe that several difficult questions of law are likely to arise on the trial of the said action, and that it is a fit one to be tried in His Majesty's High Court of Justice, and amongst other the following questions are likely to arise [here state distinctly the questions of law likely to arise; also state facts tending to show that such questions are likely to arise].

5. I have been advised and verily believe that I have a good defence to the said action on its merits.

Form of Notice of Payment into Court with a Denial

of Liability.

TAKE NOTICE that the above-named defendant has paid into Court the sum of £ in satisfaction of the whole of the plaintiff's claim herein [or, of so much of the plaintiff's claim as relates to (here describe the part of the claim or cause of action in respect of which the payment is made)].

And further take notice that notwithstanding such payment, the defendant denies his liability.

And further take notice that the address of the said defendant is as follows [state the address].

Dated, etc.

To the Registrar of the Court, and

C. D., the above-named defendant [or, E. F., solicitor for the above-named defendant].

to A. B., the above-named plaintiff.

APPENDIX H.

Forms of Special Defence and Counterclaim.

TAKE NOTICE that the defendant intends at the hearing of this action to claim a set-off [or, to set up a counter-claim] against the plaintiff's demand, the particulars of which are annexed hereto.

Dated this

day of

19

the defendant [or, 's solicitor].

Take notice that the defendant intends at the hearing of this action to give in evidence or rely upon the following ground of defence. Dated this

day of

To the Registrar of the Court.

19

the defendant [or, 's solicitor].

That the defendant was an infant, within the age of twenty-one years, when the supposed claim arose, and that he was born, as he believes, at

in the county of

on the

day of

That the claim for which the defendant is summoned is barred by a Statute of Limitation (43 & 44 Vict. c. 42, s. 4).

That no notice of the alleged injury was given to the defendant pursuant to 43 & 44 Vict. c. 42, s. 4.

The plaintiff [or defendant] applies to have an assessor [or assessors] appointed to assist the Court in ascertaining the amount of compensation to be awarded to the plaintiff should the judgment be in his favour, and he submits the names of the following persons who have expressed their willingness in writing to act as assessors should they be appointed:

[Here set out names, addresses, and occupations of the persons referred to.]

(y) The defendant [or plaintiff] consents to the appointment of any of the persons above named to act as assessors in this action as appears by his consent thereto filed herewith.

plaintiff [or defendant].

APPENDIX K.

Form of Application for New Trial.

In the County Court of

holden at

A. B.

and

C. D.

Take notice, that on (z)

the

application will be made on behalf of the plaintiff [or defendant], at the sitting of the Court for an order directing that the verdict and judgment entered herein on the 19 , may be set aside, and that a new trial be ordered between the parties on the following grounds:

day of

That the verdict was against the weight of evidence [or, that the judge misdirected himself on a point of law to wit-or, that the amount of the damages was excessive--or, that the plaintiff (or defendant) has since the trial discovered fresh evidence not obtainable by reasonable diligence at the time of the trial].

Dated this

day of

To the Registrar and C. D.,

the defendant [or plaintiff].

A. B., Solicitor to the plaintiff [or defendant].

(y) Where the other party does not consent, or where the other party has filed an application for the appointment of assessors, strike this paragraph out.

(z) Insert the date of the first sitting of the Court after twelve clear days from the judgment. The notice must be served seven clear days before the date of such sitting.