Editable PDF: Form 55A: Capacity Application
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.