And whereas a judgment summons was issued against you and heard at the Magistrate's Court at
, on the day of , 19 , and the said judgment was by the Court varied by
an order for the payment of the same by instalments :
And whereas it appears you have made default in the payment of the instalment due on the
day of , and there is now due to the plaintiff in respect of the said instalment the
sum of £ :
You are therefore hereby summoned to appear personally at the Magistrate’s Court at [Place where
Court is holden], on the day of , 19 , at the hour of in the noon,
to be examined on oath by the Court as to whether [Strike out paragraph No. 1 or 2 so as to follow
application]—
(1.) After providing for the reasonable maintenance of yourself and your family you have
not since the date of the judgment [or order] had sufficient money to pay the debt; or
(2.) You have not since the date of the order to pay the debt by instalments had sufficient
money to pay the instalment so due [as the case may be]; or
(3.) [If fraud is alleged it must be specifically stated as in the application for judgment summons];
and also to show cause why you should not be committed to prison for such default.
Given under my hand, and the seal of the Court, this day of , 19
, Clerk of the Court.

Amount of judgment [or order] and costs
Costs of warrant against the goods, if any
Costs of previous judgment summons

Deduct{ Paid on account
Amounts which were not required to have been paid before the date of
summons

Sum payable
Cost of the summons

Amount upon the payment of which no further proceedings will be had until default in payment of next instalment

I, , Bailiff of the Magistrate’s Court at , do swear that I have duly served the within-
named with a summons, a true copy of which is within written, by delivering the same to
him personally at , on the day of , 19
[Signature of Deponent.]
Sworn at , this day of , 19 , before me, , a Justice of the
Peace for New Zealand [or Clerk of Court, or Solicitor].

[Debt Form 19.
JUDGMENT SUMMONS ON AN ORDER OR JUDGMENT AFTER A PREVIOUS SUMMONS HAS BEEN HEARD.
The Imprisonment for Debt Limitation Act, 1908, and the Magistrates’ Courts Act, 1908.
No. of plaint : /19
No. of judgment summons : /19
In the Magistrate’s Court holden at
Between , of [Address and description], plaintiff, and , of [Present address and
description, and, if known, place of employment], defendant.
WHEREAS the plaintiff obtained a judgment [or, if no judgment has been obtained, or if a fresh order has
been obtained upon a judgment, an order] against you, the above-named defendant, in the Magistrate’s
Court holden at , on the day of , 19 , for the payment of £
for debt [or damages] and costs, and subsequent costs have been incurred in pursuance thereof amount-
ing to £
And whereas a judgment summons was heard and determined in the Magistrate’s Court at
, on the day of , 19 , and no order was made thereon:
And whereas it appears that you have still made default in payment of the sum payable in
pursuance of such judgment [or order, or of an instalment due on the day of , 19 ],
and there is now due and owing thereunder to the plaintiff the sum of £
You are therefore hereby summoned to appear personally at the Magistrate’s Court at [Place where
Court holden], on the day of , 19 , at the hour of in the noon, to
be examined on oath by the Court as to whether, after providing for the reasonable maintenance of