To: The Registrar
PO Box 5022 (DX SP22525)
1. I/We [Insert name(s), address(es), occupation(s), iwi/hapū, am/are Māori]
2. For ourselves and [Names of any group(s) on whose behalf the claim is made, eg:
'For myself and the descendants of Tamatū of which I am one'; or
'For ourselves and Ngāti Iti, of which we are members, and with the support of the Ngāti Whānui Māori Trust Board on which Ngāti Iti is represented'; or
'For ourselves and the several tribes shown opposite our names']
3. Claim we are/are likely to be prejudicially affected by [Here describe your claim].
[Note: Remember that, under section 6 of the Treaty of Waitangi Act 1975, the claim may be made only in terms of policies or practices or actions or omissions of the Crown, or in relation to Acts of Parliament or other statutory instruments. The Tribunal cannot inquire into a Bill that has been introduced into Parliament.]
And we claim that these matters are contrary to the principles of the Treaty of Waitangi.
4. We seek the following relief:
[Note: Although there is no requirement that you state in advance of a hearing the compensation that you are seeking, you may set this out. Sometimes, claimants initially seek a finding that a claim is well founded and ask for permission to nominate the particular compensation at a later date. However, claimants seeking the return of memorialised land or Crown forest land under the Tribunal's binding powers should advise the Tribunal of that here. If you set out the compensation you are seeking, you should add at the end 'and such other relief as the Tribunal considers appropriate'.]
5. We wish the Tribunal to commission a researcher to report on the claim.
[Note: If you ask for research assistance, you will be required to provide a research proposal setting out: the research topic; the type of sources that need to be researched and their location; an outline of the report's structure; the names and qualifications of the researcher(s) to be used; a timetable; and a budget.]
6 We ask for permission to amend this claim, if necessary.
7. The Tribunal is advised that our legal representative is [Name of your lawyer (if you have one) and their full postal address and fax and telephone numbers].
[Note: Civil legal aid is available for Waitangi Tribunal matters.
Applications should be sent to:
Legal Services Agency
PO Box 5333
Application forms may be obtained from Legal Services Agency or the Tribunal.]
8. We wish the claim to be heard at [Name venue].
[Note: If you wish the claim to be heard at a particular place, such as a specific marae, please state this here.]
9. We believe the following persons and organisations should be notified of this claim: [List names and addresses]
[Note: Those affected could be other Māori, Government departments, corporations, local authorities, or private individuals. Please list all those you think could be affected by the claim and provide addresses where possible. Remember that it is important for the Tribunal to notify everyone who might be affected. Failure to give adequate notice may invalidate the Tribunal's proceedings.]
10. This claim amends/replaces our earlier claim of [Date of earlier claim].
[Note: If this claim is in addition to an earlier claim, please fill in the date the earlier claim was made. Usually, the same people who submitted the original claim must submit any addition to it or an amended statement of claim. Omit this section if this is your first statement of claim.]
11. We can be contacted care of the following address: [Address for service]
[Note: It is important that you include a residential address (in addition to any box number) and a telephone number at which Waitangi Tribunal staff or parties to the claim can easily contact you. This may be the address of a person making the claim, but if you have a lawyer, their address will normally be the address for service.]
Name(s): [Print name(s)]
Signature(s): [Your signature(s)]