Small Claims Court Claim Form – Double M Advocates

Claimant’s Personal Details *

First

Last

ID NO. *

Mobile NO. *

Email *

Email

Confirm Email

Physical Address *

Indicate Location/Sub-location/Village

Occupation *

Claiming in Person or as a Representative *

Represented Person’s Name

First

Last

Represented Person’s Additional Details

Include ID NO, Phone NO. Email, Physical Address and Occupation.

Reason for Acting as a Representative

Respondent’s Personal Details *

First

Last

Events the Claimant’s

Legal Status of the Respondent *

Nature of Claim *

Goods sold and delivered valued at amount declared in this form
Services rendered valued at amount declared in this form
Contract relating to money received valued at amount declared in this form
Compensation for loss or damage to property valued at amount declared in this form
Compensation for personal injury valued at amount declared in this form

Declared value of the claim in KES *

Date of the Events Leading to this Claim *

Circumstances of the Claim *

Remedy/Relief Sought(Tick where appropriate) *

General Damages for breach of Contract
Payment of debt owed in the amount of the value declared
Special Damages
Compensation to be determined by the court
Costs of the claim to be assessed by the court
Other appropriate relief (Interest at Court rates from date of filing the claim until payment in full)

Tick any or all of the above.

Waiver Clause *

By filing this claim, the claimant waives the right to recover any amount exceeding KES 1,000,000 excluding costs and interest.

Additional Notes or Information