FORM 1 Summary Cause Summons Action for/of (state type, e.g. payment of money)	OFFICIAL USE ONLY SUMMONS No.

Sheriff Court (name, address, e-mail and telephone no.)

1

Sheriff Court 27 Chambers St, Edinburgh EH1 1LB 0131 225 2525 [e-mail]

Name and address of person raising the action (pursuer)

2

Mr Kenneth Dale-Risk 36 Marchmount Grove, Edinburgh, EH3 1DR [e-mail]

Name and address of person against whom action raised (defender, arrestee, etc.)

3

Dr Lesley-Anne Macfarlane Flat 2/4 Westraw House Carmichael, Lanark ML11 5MW

Name(s) and address(es) of any interested party (e.g. connected person)

3a

None

Claim (form of decree or other order sought)

4

The pursuer claims from the defender the sum of £5,000 with interest on that sum at the rate of xx annually from 18 of August 2014 together with the expenses of bringing the action.

Name, full address, telephone no, and e-mail address of pursuer’s solicitor or representative (if any) acting in the case

5

D’Illusional, Stumped and Finck, WS 2 Rutland Gardens Edinburgh EH1 1AA Office Tel: [phone]

Fee Details (Enter these only if forms sent electronically to court)

5a

	6	RETURN DAY 20
		CALLING DATE 20 at am.
*Sheriff Clerk to delete as appropriate Court Authentication		The pursuer is authorised to serve a copy summons in form *1a/1b/1c/1d/1e/1f, on the defender, and give intimation to any interested party, not less than * 21/42 days before the RETURN DAY shown in the box above. The summons is warrant for service, and for citation of witnesses to attend court on any future date at which evidence may be led. Sheriff clerk depute (name)             Date:              20  Â

NOTE: The pursuer should complete boxes 1 to 5a above and box 7 on page 2. The sheriff clerk will complete box 6.

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7.

STATE DETAILS OF CLAIM HERE (all cases) and PARTICULARS OF ARRESTMENT (furthcoming actions only) (To be completed by the pursuer. If space is insufficient, a separate sheet may be attached) The details of the claim are: 1. The pursuer is Mr Kenneth Dale-Risk born on the 03/10/1974. He resides at 36 Marchmount Grove, Edinburgh, EH3 1DR. His date of birth is 03/10/1974. The pursuer is a free-lance opera reviewer. 2. The defender is Dr Lesley-Anne Macfarlane. She resides at Flat 2/4, Westraw House, Carmichael, Lanark, ML11 5MW. 3. The court has jurisdiction to hear this claim against the defender because the pursuer is asking for reparation for loss, injury and damage sustained by him through the fault and contributory negligence of the defender. The event that caused the loss, injury and damage happened on Colinton Road, Edinburgh. This court therefore has jurisdiction. 4. On 18 August 2014, the pursuer was cycling up Colinton Road, Edinburgh. He passed the crossroads beside Glenlockhart Road when, suddenly and without warning, a car - a black VW Polo - swerved, colliding with front his wheel. He was thrown forward, over his handlebars, landing on his left side. The defender, Dr Lesley-Anne Macfarlane, was driving the vehicle. She continued beyond the crossroads and stopped the vehicle. According to Mr Dale-Risk and the witness there was fortunately no other traffic or other passing vehicles that could have hit him. The driver, Dr Barnes-Macfarlane, ran over to Mr Dale-Risk. She escorted him to the side of the main road. From a witness statement given by Mrs E. Fisher, it is known that it was the sudden appearance of a dog on the road that caused her to make the sudden manoeuvre. 6. As a result of the accident, the pursuer has suffered loss, injury and damage. He was taken by ambulance to the A&E and diagnosed with suffering mild concussion as a result of his head hitting the road. There was also an abrasion to his forehead and left cheek, suggested by the paramedics, cheekbone fracture and collarbone fractured. His left arm was very painful and he had difficulty closing his fingers on his left hand. His left hip was tender and his suit trousers were shredded and blood stained. As a direct result of the accident, Mr Dale-Risk was not capable of performing the interview. It was a rare career opportunity that was lost. 7. The pursuer is claiming (1) solatium, (2) Loss of congenial employment, (3) cost of repair or equivalent of the value of the bike, (4) incidental expenses incurred as a result of the accident, (5) loss of wages. 8. The pursuer’s claims on the grounds of breach of common law obligations. The driver failed to take reasonable care for the safety of other road users when reacting to a hazard and failed to avoid collision.

FOR OFFICIAL USE ONLY Sheriff’s notes as to: 1. Issues of fact and law in dispute 2. Facts agreed 3. Reasons for any final disposal at the hearing held on the calling date.

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FORM 1e	OFFICIAL USE ONLY SUMMONS No.
Summary Cause Summons
Personal Injuries Action

DEFENDER’S COPY: Claim for payment of money in a personal injuries action (where time to pay direction may be applied for)

Sheriff Court

(name, address, e-mail and telephone no.)

Name and address of person raising the action (pursuer)

Name and address of person against whom action raised (defender, arrestee, etc.)

Name(s) and address(es) of any interested party (e.g. connected person)

Claim (form of decree or other order sought)

Name, full address, telephone no., and e-mail address of pursuer’s solicitor or representative (if any) acting in the case

NOTE: You will find details of the claim in the attached Form 10 (statement of claim in a personal injuries action).

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SECTION A	27 Chambers St		Summons No
This section must be completed before service	Edinburgh		Return Day
	EH1 1LB
			Calling Date
	SHERIFF COURT (Including address)
	Mr Kenneth Dale-Risk		Dr Lesley-Anne Macfarlane
	36 Marchmount Grove		Flat 2/4 Westraw House
	Edinburgh		Carmichael, Lanark
	EH3 1DR		ML11 5MW
	PURSUER’S FULL NAME AND ADDRESS		DEFENDER’S FULL NAME AND ADDRESS
SECTION B	DEFENDER’S RESPONSE TO THE SUMMONS
	** Delete those boxes which do not apply
**Box 1	ADMIT LIABILITY FOR THE CLAIM and make written application to pay by instalments or by deferred lump sum.
	I do not intend to defend the case but admit liability for the claim.
	I wish to make a written application about payment.
	I have completed the application form on pages 7 and 8.
**Box 2	ADMIT LIABILITY FOR THE CLAIM and attend at court to make application to pay by instalments or deferred lump sum.
	I admit liability for the claim.
	I intend to appear or be represented at court on the calling date
**Box 3	DISPUTE THE CLAIM (or the amount due)
	*I intend to challenge the jurisdiction of the court.
	*I intend to challenge the competency of the action.
	*I intend to defend the action/state a counterclaim.