A.B., the above named plaintiff, states as follows:–
I. On the ……. day of ………. 20…….., he lent the defendant ……. rupees repayable on the …… day of…….
2. The defendant has not paid the same, except rupees …… paid on the ……. day of …….20……
[If the plaintiff claims exemption from any law of limitation, say:–]
3. The plaintiff was a minor [or insane] from the …… day of ……. till the ……… day of…….
4. [Facts showing when the cause of action arose and that the court has jurisdiction.]
5. The value of the subject-matter of the suit for the purpose of jurisdiction is…… rupees and for the purpose
of Court fee is ….. rupees.
6. The plaintiff claims …… rupees, with interest at ……. per cent from the …….. day of …….20….