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This is an example of a completed acknowledgement of liquidated claim. It is important to complete this form using your own details and based on your own circumstances. If you need more help, get legal advice. Do not try to file this sample form at court.
This sample form is provided in Word format.
Sample acknowledgement of liquidated claim (37kb)
For more information on completing this form, see Instructions for filling out an acknowledgement of liquidated claim.
This sample form is based on the following case study:
Case study - Meena and Fantastic Florists
runs a small business from home, doing website design and IT support for other
small businesses. One of her regular clients, Fantastic Florists, has failed to
pay her invoice in the amount of $4,000 for the website she built. Meena sent a
couple of reminder letters but there has been no response. She tried to contact
Fiona from Fantastic Florists by telephone but could not reach her. Meena sent a letter of demand to Fantastic
Florists. Fiona from Fantastic Florists offered to pay for part of the
outstanding invoice. Meena refused Fiona’s offer and has started legal action
in the Small Claims Division of the Local Court to recover the outstanding
amount from Fantastic Florists. Fiona
was served with a statement of claim. Fiona agrees she owes the debt and wants
to pay by instalments. Fiona prepares an acknowledgement of liquidated claim and
a notice of motion to pay by instalments.