If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email email@example.com.
Please tell us what format you need. It will help us if you say what assistive technology you use.
This form is called an ‘acknowledgment of service’. The court will send this form to a defendant with the claim.
Read the notes on the second page of the form before filling it in.