Form 5.25	Court of Appeal—special case
Court Procedures Rules 2006
(see r 5832 (Question referred to Court of Appeal—form))
In the Supreme Court of the Australian Capital Territory
Court of Appeal
No ACTCA		of (year)
Special case from *[Justice (name of judge)/Associate Judge (name of associate judge)]
No SC		of (year)
(name)
Applicant

(name)
Other active *[party/parties]

Question to be decided
(state the question(s) to be decided)
Statement of facts
(briefly state the facts and attach all documents necessary to allow the Court to decide the question(s) raised)
Documents
The following documents are attached:
(attach all documents necessary to allow the Court to decide the question(s) raised)
(if r 5832 (3) applies)
*[Written case
The special case is to be presented in writing.]
Applicant’s address for service of documents
(set out applicant’s address for service)
(if represented by a solicitor the following information may be given)
*Document exchange box no:
(if postal address different from address for service)
*Postal address:
*Fax:
*Email address:
Other active party’s address for service of documents
(set out each other active party’s address for service)
(if represented by a solicitor the following information may be given)
*Document exchange box no:
(if postal address different from address for service)
*Postal address:
*Fax:
*Email address:

Date:
(signature of applicant/applicant’s solicitor)
(name of applicant/applicant’s solicitor)

*omit if, or whichever is, inapplicable