S.I. No. 201/2023 - Circuit Court Rules (Assisted decision-making (Capacity) Act 2015) 2023

Schedule 2

Form 55A

An Chúirt Chuarda

The Circuit Court

Capacity Application

Record Number: …
Circuit …							County …

In the Matter of Part 5 of the Assisted Decision-Making (Capacity) Act 2015 ,

as amended

And In the Matter of

Relevant Person
Name: …						Address: …

Application of

Applicant(s)
Name(s): …					Address(es): …

TAKE NOTICE that on

Date of Hearing: …				at Time: …
Court Venue: …

the applicant will apply for orders as set out in this document:

At the time this application is made, the relevant person: (Please select one)

□ Resides in this Circuit

□ Carries on business in this Circuit, please provide address below

…

□ Has resided in this Circuit at any time during the last 3 years, please provide address below

…

Specify which of the following orders are intended to be sought

What declarations are you applying for? (Please select all that apply)

□ A declaration under Section 37(1)(a), that the Relevant Person lacks capacity, unless the assistance of a suitable person as a co-decision maker is made available to him/her to make the below decisions jointly with him/her in relation to his/her:

□	Personal welfare
□	Property and affairs

Please give details below

…

□ A declaration under Section 37(1)(b), that the Relevant Person lacks capacity even if the assistance of a suitable person as a co-decision maker were made available to him/her to make the below decisions in relation to his/her:

□	Personal welfare
□	Property and affairs

Please give details below

…

□ A declaration under section 37(3) of the Act as to the lawfulness of the following intervention in respect of the Relevant Person (please give details): …

Which order are you applying for? (Please select all that apply)

□ An order under section 38(2)(a) of the Act making the following decision(s) as outlined below, on behalf of the Relevant Person, where the court is satisfied that the matter is urgent or expedient (please give details): …

□ An order under section 38(2)(b) of the Act to appoint a decision-making representative for the Relevant Person for the following decisions (please give details): …

□ An interim order under section 48 of the Act providing for (please give details): …

Do you know of a suitable person who would be willing to act as a decision-making representative for the Relevant Person?

If yes, please provide details of this person in Form 55B.

□ Yes

□ No

Signatures:

Signature of applicant(s)/Solicitor for applicant(s): …

Date: …

Solicitor Details (if applicable)

Name and Address of Solicitor: …
Email: …						Phone Number: …

To:

Name and Address of Court office: …

Name and address of Notice Party(s) (if applicable): …

You should consider taking legal advice on this document.

If you are the Relevant Person to whom this Capacity Application relates (i.e. the person in respect of whom a declaration concerning capacity is sought), you may reply to the application by completing Form 55C (or if you have a solicitor, your solicitor may do so). Copies of the completed form should be sent to the applicant or applicant’s solicitor at the address given above and to the Court Office at the address above at least seven days before the hearing date.

You are also free to deliver evidence by affidavit or, if the Court permits, in another manner. If you have a solicitor, he or she can advise you about this. You may attend the hearing in person and/or your solicitor can attend on your behalf.

Form 55B

An Chúirt Chuarda

The Circuit Court

Record Number:

…

Capacity Application: Statement of Particulars

Part 5 of the Assisted Decision-Making (Capacity) Act 2015 , as amended

This form must be completed for all applications.

All information provided must be verified by affidavit

A) Details of the Relevant Person:

Name: …					Date of Birth: …
Phone Number: …	Phone Number: …				Marital/civil partnership status: …

B) Relationship of the applicant(s) to the Relevant Person:

What is the applicant’s relationship or connection to the Relevant Person or the capacity in which the applicant makes the application? (Please select one)

□ I am the Relevant Person

□ The Director

□ The spouse or civil partner of the Relevant Person

□ A decision-making assistant for the Relevant Person

□ A decision-making representative for the Relevant Person

□ The co-habitant of the Relevant Person

□ A co-decision-maker for the Relevant Person

□ A designated healthcare representative for the Relevant Person

□ An attorney acting under an enduring power of attorney for the Relevant Person

□ A child of the Relevant Person who has attained the age of 18 years

□ A person specified for that purpose in an existing order of the court under this Part where the application relates to that order

□ A person / body prescribed by Ministerial regulations under section 36(4)(k)

□ If the application relates, whether in whole or in part, to the Relevant Person’s capacity to make a decision to consent to being married or to being in a civil partnership

□ a registrar within the meaning of section 17 of the Civil Registration Act 2004

□ the other party to the proposed marriage or civil partnership (if any), as the case may be, of the Relevant Person

C) If the applicant’s relationship type is not listed in the previous section:

Has consent from the Court been given under section 36 (3) of the Assisted Decision-Making (Capacity) Act 2015 ?

□ Yes

□ No

Where consent has been given by the Court, a copy of the court order must be exhibited to the grounding affidavit.

Explain the applicant’s interest in the Relevant Person’s welfare: ….

Circumstances of Application

This must be completed for all applications

D) Previous discussions:

Has the applicant discussed or considered the making of this application with the Relevant Person?

□ Yes

□ No

Please give details including their response, if any: …..

Has the applicant(s) discussed or considered the making of this application with any other person(s) mentioned in B above?

□ Yes

□ No

Please give details including their response, if any: …

E) Details of the Relevant Person:

Set out a summary of the material facts (and identify the source of any such information) relevant to this application which will assist the Court in making a declaration as to the capacity of the Relevant Person.

Please provide information in relation to the following if relevant to the application:

The health of the Relevant Person (example: eyesight, hearing, dietary requirements): …

The current living arrangements and individual circumstances of the Relevant Person (example: do they live at home, alone or with someone, and if so, have they a carer or other support? Are they in a hospital or nursing home?): …

Is the Relevant Person currently or have they ever been a ward of court?

□ Yes

□ No

If yes, please give details: …

Any other information about the Relevant Person which may be relevant to the determination of this application: …

F) Benefits of this application:

Explain the benefit to the Relevant Person sought to be achieved by this application: ….

G) Reasons for this application:

In the case of an application under Part 5 of the Assisted Decision-Making (Capacity) Act 2015 , explain the reason why the benefit to the Relevant Person sought to be achieved has failed to be achieved in any other appropriate, practicable and less intrusive manner (example: assisted decision-making; co-decision-making) taken prior to the making of this application: ….

Explain the reason why you believe that no other appropriate, practicable and less intrusive manner to achieve that benefit (example: assisted decision-making; co-decision-making) remains to be taken prior to the making of this application: ….

H) Any relevant agreements, instruments or court orders affecting the Relevant Person:

To the best of your knowledge, has the Relevant Person created any of the following:

A decision-making assistance agreement

□ Yes

□ No

A co-decision-making agreement

□ Yes

□ No

An enduring power of attorney under the ADMC Act 2015

□ Yes

□ No

An enduring power of attorney under the Powers of Attorney Act 1996

□ Yes

□ No

An advance healthcare directive

□ Yes

□ No

To the best of your knowledge, has either of the following been made in relation to the Relevant Person:

A decision-making representation order

□ Yes

□ No

A decision-making order

□ Yes

□ No

If you answered yes to any of the above, please give details: …

If you have a copy of any such agreement, instrument or court order, a copy must be exhibited to the grounding affidavit.

I) Please set out what you understand of the Relevant Person’s past and present will and preferences in relation to the application being made.

.....

J) To your knowledge, does the Relevant Person have any beliefs or values which should be taken into consideration?

□ Yes

□ No

If yes, please give details: …

Personal Welfare Decisions

It is only necessary to complete this section of the form where your application includes an application for a declaration that the Relevant Person lacks capacity to make one or more than one decision relating to their personal welfare.

K) Please identify any particular needs the Relevant Person may have in relation to the making of decisions about their personal welfare:

Examples include:

• • Accommodation, including whether or not the Relevant Person should live in a designated centre (i.e. a residential institution for persons with dependencies or disabilities or a nursing home)

• • Participation in employment, education or training

• • Decisions on any social services provided or to be provided to the Relevant Person

• • Healthcare

• • Participation in social activities

• • Participation in healthcare / social care research

• • Other matters relating to the Relevant Person’s well-being

..............

You should exhibit copies of all relevant correspondence and documents which may be relevant to the needs identified. Those copies shall be incorporated in a single exhibit, indexed and numbered sequentially in chronological order.

Property and Affairs Decisions

It is only necessary to complete this section of the form where your application includes an application for a declaration that the Relevant Person lacks capacity to make one or more than one decision relating to their property and affairs.

If the application is being made in relation to a particular property or transaction only, and not to the Relevant Person’s property and affairs generally, it is only necessary to provide details of the property to which the application relates or of the matters to which the transaction relates.

L) Please identify any particular needs the Relevant Person may have in relation to the making of decisions about the following:

The custody, control and management of some or all of the Relevant Person’s property or property rights. Please give details: ….

The sale, exchange, mortgaging, charging, gift or other disposition of the Relevant Person’s property (example: whether you believe it might become necessary to sell the Relevant Person’s home or other assets to meet the cost of accommodation or care) Please give details: ….

The acquisition of property by the Relevant Person, or on his or her behalf. Please give details: ….

The carrying on, on behalf of the Relevant Person, of any profession, trade or business which may lawfully be carried on by a person other than the Relevant Person (example: the management of any business which the Relevant Person owns or operates which he or she might not in future be able to undertake). Please give details: ….

The making of a decision which will have the effect of dissolving a partnership in which the Relevant Person is a partner. Please give details: ….

The carrying out of any contract entered into by the Relevant Person. Please give details: ….

The discharge of the Relevant Person’s debts, tax and duty liabilities and obligations or other obligations. Please give details: ….

The execution or exercise of any of the powers or discretions vested in the Relevant Person as a tenant for life. Please give details: ….

Providing, to the extent that the Relevant Person might have been expected to do so, for the needs of a decision-making assistant, a co-decision-maker, an attorney, a designated healthcare representative or a decision-making representative for the Relevant Person or of other persons. Please give details: ....

The conduct of proceedings before any court or tribunal, whether in the name of the Relevant Person or on his or her behalf. Please give details: ....

Making an application for housing, social welfare or other benefits or otherwise protecting or advancing the interests of the Relevant Person in relation to those matters. Please give details: ....

M) Please provide a summary, so far as you know, of the nature and approximate value of the Relevant Person’s assets:

Description of asset:					Estimated value (€):
................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................
Total Estimated value (€)	Total Estimated value (€)		......................................	......................................	......................................

Are any of these assets subject to a mortgage, charge or third party rights?

□ Yes

□ No

If yes, please give details: .....

N) Please provide a summary, so far as you know, of the nature and approximate value of the Relevant Person’s liabilities:

Description of liability:				Estimated value (€):
................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................
Total Estimated value (€)	Total Estimated value (€)		......................................	......................................

O) Please provide a summary, so far as you know, of the nature and approximate amount of the Relevant Person’s monthly income (indicating the source where known to you):

Description of income:				Estimated value (€):
................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................
Total Estimated value (€)	Total Estimated value (€)		......................................	......................................

P) Please provide a summary, so far as you know, of the nature and approximate amount of the Relevant Person’s monthly spending:

Description of expense:					Estimated cost (€):
................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................	................................................. ......................................
Total Estimated cost(€)	Total Estimated cost(€)		......................................	......................................	......................................

Q) Please provide a summary of the Relevant Person’s dependants (people they look after financially):

Number of dependants under 18 years of age (if any): ....

Other dependants (give details): ....

Possible Co Decision-Maker

R) Possible Co-Decision Maker:

If the Court declares that the Relevant Person lacks capacity, unless the assistance of a suitable person as a co-decision-maker (CDM) is made available to him or her, to make one or more than one decision specified in the Court’s declaration relating to his or her personal welfare or property and affairs, or both, do you know of a suitable person who would be willing to act as a co-decision-maker for the Relevant Person?

□ Yes

□ No

If you answered yes to the above, complete below:

Name(s) of suitable person(s): ....

Address(es) of suitable person(s): ....

Relationship(s) to the Relevant Person: ....

If any person proposed to act as a CDM has confirmed his or her consent to act as such, a copy of the consent must be exhibited to the grounding affidavit.

Please give reasons why that person would be suitable as a Co-Decision Maker: .....

Possible Decision-Making Representative

S) Possible Decision-Making Representative

If the Court declares that the Relevant Person lacks capacity, even if the assistance of a suitable person as a co-decision-maker (CDM) is made available to him or her, to make one or more than one decision specified in the Court’s declaration relating to his or her personal welfare or property and affairs, or both, do you know of a suitable person who would be willing to act as a decision making representative (DMR) for the Relevant Person?

□ Yes

□ No

If you answered yes to the above, complete below:

Name(s) of suitable person(s): ....

Address(es) of suitable person(s): ....

Email of suitable person(s): ....

Phone Number of suitable person(s): ....

Relationship(s) to the Relevant Person: ....

If any person proposed to act as a DMR has confirmed his or her consent to act as such, a copy of the consent must be exhibited to the grounding affidavit.

When considering the suitability of a person to be a decision-making representative for a relevant person, the court shall have regard to the following:

• • The known will and preferences of the relevant person

• • The desirability of preserving existing relationships within the family of the Relevant Person

• • The relationship (if any) between the relevant person and the proposed representative

• • The compatibility of the proposed representative and the relevant person

• • Whether the proposed representative will be able to perform the functions to be vested in him or her

• • Any conflict of interest

Where the court appoints a decision-making representative to make decisions on the relevant person’s property and affairs, it shall have regard to the following

• • The size, nature and complexity of the relevant person’s financial affairs

• • Any professional expertise, qualification or experience required to manage the relevant person’s financial affairs

• • The capability of the proposed representative to manage the relevant person’s property and affairs

• • The financial expertise and support available to the proposed representative

Please give reasons why that person would be suitable as a decision-making representative: ......

Declaration sought of lawfulness of proposed intervention

T) Complete this section of the form if you have included in your application that:

You are asking for declaration as to the lawfulness of an intervention proposed to be made in respect of the Relevant Person, under section 37(3) of the Act.

For the purposes of an application under section 37(3) of the Act, an ‘intervention’ means an action taken under the Assisted Decision-Making Capacity Act 2015 by:

• • A decision-making assistant, co-decision-maker, decision-making representative, attorney or designated healthcare representative

• • The Director of the Decision Support Service

• • A special visitor or general visitor

• • A healthcare professional

• • Court Friend

• • A person found suitable by the Court to assist the Relevant Person

Does the applicant wish the Court to make a declaration as to the lawfulness of any intervention proposed in relation to the Relevant Person, and if so, provide details of the proposed intervention .......

U) Additional information for your application:

Please provide any additional information not already provided above, to which you believe the Court should have regard in considering your application ..........

V) Signatures:

Signature of applicant(s)/Solicitor for applicant(s): ......

Date: ....

Solicitor Details (if applicable)

Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....
Email: ....					Phone Number: ....

The statement of particulars must be verified by an affidavit (Form 55I). When served on the relevant person, a form of reply (Form 55C) should also be served.

Form 55C

An Chúirt Chuarda

The Circuit Court

Reply to Capacity Application

Part 5 of the Assisted Decision-Making (Capacity) Act 2015 , as amended

Complete this form if you wish to respond to a Capacity application

Record Number: ...	Record Number: ...
Circuit...						County ....

Application details:

Name of Relevant Person: ...

Name of applicant(s): ...

Hearing date: ...

Your response as the Relevant Person:

How would you like to respond to the application? (Please select one):

□ I do not object to the application

□ I do not agree with the application

If you do not agree with the application, please give your reasons .......

Please set out any further information which you think should be brought to the Court’s attention: ....

Court hearing:

If you are attending the hearing and require special assistance or facilities, please list them below:

.......

Signatures:

Signature of relevant person/Solicitor for relevant persons: ...

Date: ...

Solicitor Details (if applicable)

Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...
Email: ...					Phone Number: ...

To:

Name and Address of Court office: ...

Name and address of Applicant: ...

Form 55D

An Chúirt Chuarda

The Circuit Court

CIRCUIT	COUNTY OF

Record number:

In the matter of the Assisted Decision-Making (Capacity) Act 2015 and in the matter of .......................of ........................, (relevant person)(ward)

*CAPACITY APPLICATION

PART 5 OF THE ASSISTED DECISION-MAKING (CAPACITY) ACT 2015

*DISCHARGE APPLICATION

PART 6 OF THE ASSISTED DECISION-MAKING (CAPACITY) ACT 2015

Application of............................of .............................., Applicant(s)

AFFIDAVIT OF SERVICE ON A RELEVANT PERSON OR A WARD

I, [name] of [address] aged 18 years and upwards, make oath and say as follows:—

(Capacity Application) (Discharge Application), Statement of Particulars and grounding affidavit(s) (and any exhibits), and form for reply,

• *(Originating) notice of motion, and grounding affidavit(s) (and any exhibits), and form for reply,

and at the same time delivering to him/her in person and leaving with him/her true copies of the same.

[or explain what action was taken in this regard]

Sworn etc.

Form 55E

An Chuirt Chuarda

The Circuit Court

Notice of Motion

Record Number: ...	Record Number: ...
Circuit ...						County ...

In the Matter of the Assisted Decision-Making (Capacity) Act 2015 ,

as amended

Part: ...				Section: ...

Is this an Originating Notice of Motion?

□ Yes

□ No

And In the Matter of

Relevant Person

Name: ...						Address: ...

Application of

Applicant(s)

Name: ...						Address: ...

And

Respondent(s) (if applicable)

Name: ...						Address: ...

TAKE NOTICE that on

Date of Hearing: ...				at Time: ...
Court Venue: ...

the Applicant will apply for orders as set out in this document, and for such further or other orders as the Court is empowered to make under said Act.

Affidavit Details:

WHICH application will be grounded upon the following affidavit(s) and the nature of the case and the reasons to be offered:

Affidavit of:							Sworn on (date)
..............................................................	..............................................................	..............................................................	..............................................................	..............................................................	..............................................................	..............................................................

Details of Order(s) requested:

.....................

Signatures:

Signature of applicant(s)/Solicitor for applicant(s): ...

Date: ...

Solicitor Details (if applicable)

Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...
Email: ...						Phone Number: ...

To:

Name and Address of Court office: ...

Name and address of Notice Party(s) (if applicable): ...

You should consider taking legal advice on this document.

If you are the Relevant Person to whom this application relates, you may reply to the application by completing Form 55F (or if you have a solicitor, your solicitor may do so).

The completed form should be sent to the applicant or applicant’s solicitor at the address given above and to the Court Office at the address above at least seven days before the hearing date.

You may also deliver evidence by affidavit or, if the Court permits, in another manner. You may attend the hearing in person and/or your solicitor can attend on your behalf.

Form 55F

An Chúirt Chuarda

The Circuit Court

Reply to Notice of Motion

Record Number: ...	Record Number: ...
Circuit ...						County ...

In the Matter of the Assisted Decision-Making (Capacity) Act 2015 , as amended

Part: ...				Section: ...

And In the Matter of

Relevant Person:

Name: ...						Address: ...
Name of Applicant: ...	Name of Applicant: ...	Name of Applicant: ...

Your response:

How would you like to respond to the application/appeal? (Please select one):

□ I do not object to the application/appeal

□ I do not agree with the application/appeal

If you do not agree with the application/appeal, please give your reasons: .....

Please set out any further information which you think should be brought to the Court’s attention: ....

Court hearing:

If you are attending the hearing and require special assistance or facilities, please list them below:

....

Signatures:

Signature of Relevant Person/Solicitor for Relevant Person: ...

Date: ....

Solicitor Details (if applicable)

Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...	Name and Address of Solicitor: ...
Email: ...						Phone Number: ...

To:

Name and Address of Court office: ...

Name and address of Applicant/Appellant: ...

Form 55G

An Chúirt Chuarda

The Circuit Court

Ex-Parte Consent Application

Notice of Motion

Record Number: ...	Record Number: ...
Circuit ...						County ...

In the Matter of the Assisted Decision-Making (Capacity) Act 2015 , as amended

Part: ...				Section: ...

And In the Matter of

Relevant Person

Name: ...						Address: ...

Application of

Applicant(s)

Name: ...						Address: ...

TAKE NOTICE that on

Date of Hearing: ...				at Time: ...
Court Venue: ...

the applicant will apply for orders as set out in this document, and for such further or other orders as the Court is empowered to make under said Act.

Affidavit Details:

WHICH application will be grounded upon the following affidavit(s) and the nature of the case and the reasons to be offered:

Affidavit of:							Sworn on (date)
.............................................................. .......................................	.............................................................. .......................................	.............................................................. .......................................	.............................................................. .......................................	.............................................................. .......................................	.............................................................. .......................................	.............................................................. .......................................

Details of Order(s) requested:

..........

Signatures:

Signature of applicant(s)/Solicitor for applicant(s): ...

Date: ....

Solicitor Details (if applicable)

Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....	Name and Address of Solicitor: ....
Email: ....					Phone Number: ....

To:

Name and Address of Court office: ....

Form 55H

An Chúirt Chuarda

The Circuit Court

Notice of Appeal

Record Number: ...	Record Number: ...
Circuit ...						County ...

In the Matter of the Assisted Decision-Making (Capacity) Act 2015 , as amended

Part: ...				Section: ...

And In the Matter of

Relevant Person

Name: ...						Address: ...

Appeal of

Appellant(s)

Name: ...						Address: ...

And

Respondent(s) (if applicable)

Name: ...						Address: ...

TAKE NOTICE that on

Date of Hearing: ...				at Time: ...
Court Venue: ...

the Appellant will apply for orders as set out in this document, and for such further or other orders as the Court is empowered to make under said Act.

Affidavit Details:

WHICH application will be grounded upon the following affidavit(s) and the nature of the case and the reasons to be offered:

Affidavit of:							Sworn on (date)
..............................................................	..............................................................	..............................................................	..............................................................	..............................................................	..............................................................	..............................................................

Details of Order(s) requested:

.............

Signatures:

Signature of appellant(s)/Solicitor for appellant(s): ...

Date: ...

Solicitor Details (if applicable)

Name and Address of Solicitor: ...

Email: ...						Phone Number: ...

To:

Name and Address of Court office: ...

Name and address of Notice Party(s)(if applicable): ...

Form 55I

An Chúirt Chuarda

The Circuit Court

CIRCUIT							COUNTY OF

Record number:

In the matter of the Assisted Decision-Making (Capacity) Act 2015 and in the matter of .......................of ........................, (relevant person)(ward)

*CAPACITY APPLICATION

PART 5 OF THE ASSISTED DECISION-MAKING (CAPACITY) ACT 2015

*DISCHARGE APPLICATION

PART 6 OF THE ASSISTED DECISION-MAKING (CAPACITY) ACT 2015

Application of............................of ..............................., Applicant(s)

AFFIDAVIT IN SUPPORT OF APPLICATION

I, [Insert name of Deponent], ............... [Insert occupation of Deponent], ................... of [Insert address of Deponent] ..................... being aged 18 years and upwards MAKE OATH and say as follows:

1.I am the applicant in the above-entitled proceedings. I make this Affidavit from facts within my own knowledge save where otherwise appears and where so appearing I believe the same to be true.

A – Verification of Application

2.I beg to refer to the Capacity Application Discharge Application herein. I also beg to refer to the above Statement of Particulars of the [Relevant Person] [Ward] I say that such of the statements therein as relate to my particulars are true and correct and such of the statements therein as relate to the particulars of the Relevant Person to whom this application relates or to any other matter I believe to be true.

3.I beg to refer to true copies of the following documents referred to or relied upon in the Statement of Particulars herein, upon each of which I have signed my name prior to the swearing hereof, namely:

...... marked “B”;

...... marked “C”;

...... marked “D”, etc.

B – Basis of jurisdiction

the said ............., the [Relevant Person] [Ward] the subject of this application is residing *carrying on business at ..................in the above-mentioned Circuit of this Honourable Court

the said ............., the [Relevant Person] [Ward] the subject of this application has resided at ..................in the above-mentioned Circuit of this Honourable Court between .........20... and .........20..., being a time during the period of three years immediately prior to the making of this application.

C – Other relevant correspondence and documents

*D – Proposals for the further conduct of the proceedings

[6. Where the applicant wishes to make proposals for the directions which may be made for the further conduct of the proceedings, set out the facts or circumstances which it is alleged justify the giving of any particular directions sought, and set out the basis of the deponent’s belief as to the existence of those facts or circumstances.]

E – Other relevant information

[7. Set out all other evidence on which the applicant relies in support of the application for relief and all other information relevant to the application and where same is contained in any report or other document, exhibit such document.]

[insert appropriate paragraph number] I accordingly pray for the relief set out in the Capacity Application herein.

SWORN etc.

*delete where inapplicable

Form 55J

An Chúirt Chuarda

The Circuit Court

CIRCUIT							COUNTY OF

Record number:

In the matter of the Assisted Decision-Making (Capacity) Act 2015 and in the matter of .......................of ........................................

STATEMENT OF DECISION MAKING REPRESENTATIVE

I, ________, the / a

Decision Making Representative for the above Relevant Person confirm that I,

• (a) understand and undertake to act in accordance with the powers conferred and the duties imposed on me by the Court, and

• (b) understand and undertake to act in accordance with the guiding principles set out in section 8 of the Assisted Decision Making (Capacity) Act 2015.

Signed: ______________

Dated: _____

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation)

These rules amend the Circuit Court Rules, by the insertion of a new Order 47B and the addition of Forms 55A to 55J to the Schedule of Forms annexed to those rules to facilitate applications to the Circuit Court for orders under the Assisted Decision-Making (Capacity) Act 2015 as amended and by the substitution of Order 2 paragraph (d), Order 6 rule 8, order 11 rule 15, Order 13 rule 1(j), Order 15 rule 3 and Order 19 rule1 of those Circuit Court Rules.

In particular these rules provide for the following -

• • applications under Part 5 of the Act for declarations as to capacity and Decision-Making Orders;

• • discharge applications and hearings under Part 6 of the Act;

• • review of declarations of capacity made under Part 5 or Part 6 of the Act;

• • applications and appeals other than under Part 5 or Part 6 of the Act.