The Small Claims Tribunals Act Page 2
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1
2Annex to Form 1
A
NATURE OF DISPUTE. Please tick
! ! ! !
1. CONTRACT FOR
1. CONTRACT FOR SALE OF
SALE OF
2. CONTRACT FOR
2. CONTRACT FOR PROVISION
PROVISION
3. 3. 3. 3. DAMAGE
DAMAGE TO PROPERTY
TO PROPERTY
4. 4. 4. 4. LEASE
LEASE NOT EXCEEDING 2 YEARS
NOT EXCEEDING 2 YEARS
1. CONTRACT FOR
1. CONTRACT FOR
SALE OF
SALE OF
2. CONTRACT FOR
2. CONTRACT FOR
PROVISION
PROVISION
DAMAGE
DAMAGE
TO PROPERTY
TO PROPERTY
LEASE
LEASE
NOT EXCEEDING 2 YEARS
NOT EXCEEDING 2 YEARS
GOODS
GOODS
GOODS
GOODS
OF SERVICES
OF SERVICES
OF SERVICES
OF SERVICES
(RESIDENTIAL PREMISES)
(RESIDENTIAL PREMISES)
(RESIDENTIAL PREMISES)
(RESIDENTIAL PREMISES)
Defective Goods
Unsatisfactory Services
Owner of Property
Breach of Tenant’s Obligation
Non-Delivery
Incomplete Services
Damage not arising from
Breach of Landlord’s Obligation
motor vehicle accident
Goods Not As Contracted
No Services Rendered
Refund of Rental Deposit
[Note: Property damage arising
Non-Payment
Non Payment
from a motor vehicle accident
Rental Arrears
cannot be claimed at SCT]
Others
Complete Boxes B, E & F
Complete Boxes B, E & F
Complete Boxes C, E & F
Complete Boxes D, E & F
B
PARTICULARS OF CLAIM
CONTRACT FOR GOODS SOLD/SERVICES PROVIDED
1
Name Type of Goods Sold or Services provided:
2
Contract Sum: $
Paid : $
3
Balance Sum: $
4
Contract Date:
Invoice Nos:
5
Date Contract Performed:
6
Date Contract Defaulted:
C
DAMAGE TO PROPERTY
1
Date of Damage:
2
Property Damaged:
3
Place Where Damage Occurred:
D
RESIDENTIAL LEASE
1
Premises at:
2
Date of Tenancy Agreement:
Monthly Rental:
E
BRIEF SUMMARY OF CLAIM
F
! ! ! !
CLAIMING FOR : Please
(1)
WORK ORDER
State nature of Work Order (in brief)
(2)
⃞ ⃞ ⃞ ⃞
MONEY ORDER
S$
[indicate amount]
(3)
⃞ ⃞ ⃞ ⃞
AND DISBURSEMENTS
CLAIM FOR COSTS IS NOT ALLOWED.
Dated this _______________ day of ___________, 200_______________
__________________________
SIGNATURE OF CLAIMANT
Claim No. __________________/ ________________ 200____________
(If a Company Claim)
Company Stamp
NAME: ______________________________________
DESIGNATION: _______________________________
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