Response to jury summons
Tell us if you are coming to jury service
Your legal duty is to do jury service. You can apply to put off your jury service to a more suitable time.
You can also apply to be excused, but only for special reasons. Please choose 1 of the options below:
I am coming to jury service
Thank you. You’re helping your community
Please complete and send page 1 and page 2
I want to put off my jury service to a more suitable time within the next 12 months
You can ask to move the date to a time that’s better for you.
Please complete and send page 1 and page 3
I can’t do jury service
You can be excused from jury service for special reasons.
Please complete and send page 1 and page 4
Give us your details
Full name:
Address:
Date of birth:
Tell us your phone and email in case we need to contact you
Cell: Home: Work:
Email:
Give us your jury summons details
This information is at the top right of your jury summons letter.
Juror ref:
Jury service date:
Court name:
I am coming to jury service
Tell us about any costs you may have to pay when doing jury service
Travel costs
I will use public transport to get to court. It will cost $ one way.
kilometres one way.
I will use a private vehicle to get to court. I will travel
If you cannot get to court by public transport or private vehicle, you may be able to use a taxi.
You must get approval before using a taxi. Please call us on 0800 268 787.
Detailed information about parking options is online at
justice.govt.nz/jury-parking.
You can get a claim form for parking costs from the court or online at
justice.govt.nz/jury-expenses.
Childcare costs
You can ask the court to pay back your childcare costs. There’s a limit to how much you can claim.
You can get more information and a claim form from the court or online at
justice.govt.nz/jury-expenses.
Do you want the payments put into your bank account?
If you give us your bank account number, we will put your juror fees, travel costs and childcare costs directly into your
account. If you don’t give us your bank account number, we will send you a cheque.
Bank account number
Please sign and date the form
Signature Date
Special requirements
If you have a disability and any special requirements, such as a sign language interpreter, please phone us
on 0800 268 787.
Send in your form
Complete, sign and print the form. You can post it to the District or High Court that summoned you for jury service using the
postage paid envelope included in your jury summons pack or scan and email the form. You will get a letter from the court within 7
working days of the court getting this form.
If you need help please call 0800 268 787 or visit
justice.govt.nz/jury-service.
click to sign
signature
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I want to put off my jury service
You are legally required to do jury service. You can apply to put off (defer) your jury service if these dates don’t work
for you. Your application to put off jury service must refer to at least 1 of the reasons below (from the Juries Act 1981).
Tell us why you want to put off your jury service
Tick 1 of the boxes below, explain your reasons and attach proof of your situation.
I have a special or pressing commitment for my business or job (Please explain your reason and attach
proof, like a letter from your employer saying why it would cause them undue hardship or serious
inconvenience if you did jury service, or a copy of a contract proving the nature of your business).
My health or disability (Please explain your reason and attach proof, like a copy of your medical certificate, a
letter from ACC, another agency or your caregiver, or your hospital or doctor’s appointment).
My family commitments (Please explain your reason and attach proof, like copies of birth certificates of
children in your care or a medical certificate).
Other personal circumstances (Please explain your reason and attach proof, like a copy of your exam
schedule, holiday itinerary or tickets).
Reason (like ‘I have a university exam on the date of jury service. I have attached a copy of my exam schedule’).
You can attach an extra page if needed.
Tell us when you can do jury service
The dates you give must be within the next 12 months and cover at least a 4 week block, so the court can choose a
new week. The 4 week block must not cover mid-December to mid-January. If you don’t give us any dates, the
court will decide on the dates. Once you’ve chosen a date, you can’t change it again.
If my request is approved, I can do jury service during the period:
starting
(must be no earlier than 8 weeks from the date of your summons)
until (must be no later than 12 months from the date of your summons)
Please sign and date the form
Signature Date
Send in your form
Complete, sign and print the form. Attach proof of your situation. You can post it to the District or High Court that summoned
you for jury service using the postage paid envelope included in your jury summons pack or scan and email the form. You will get a
letter from the court within 7 working days of the court getting this form.
If you need help please call 0800 268 787 or visit
justice.govt.nz/jury-service.
click to sign
signature
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I can’t do jury service
You are legally required to do jury service. You can apply to be excused from jury service if you are unable to put off
(defer) your jury service or are unable to perform juror duties.
Your application must refer to at least 1 of the reasons below (from the Juries Act 1981).
Tell us why you want to be excused from jury service
Tick 1 of the boxes below, explain your reasons below and attach proof of your situation.
I am over 65 (No explanation or supporting document is
needed).
If you are over 65 you can come to jury service or apply to
be excused on this occasion or permanently.
I want to be excused on this occasion
I want to be excused permanently
My health or disability (Explain your reason and attach
proof, like a medical certificate or a letter from ACC,
another agency or your caregiver).
If you have a severe health condition or disability you can
apply to be excused on this occasion or permanently.
I want to be excused on this occasion
I want to be excused permanently
A special or pressing commitment for my business
or job (Please explain your reason and attach proof, like
a letter from your employer saying why it would be very
hard for them if you did jury service or provide proof of the
nature of your business or a copy of a contract).
My family commitments (Please explain your reason
and attach proof, like a copy of a medical certificate of
copies of birth certificates of children in your care).
I live outside the jury district (Please explain if you live
more than 45 kilometres away from the court or outside of
New Zealand. Please attach proof like a copy of mail sent
to your current address. If you don’t live in NZ, update
your address on the electoral roll at elections.org.nz).
I am a practising member of a religion that says
jury service is against its beliefs (Explain your reason
below and attach proof, like an official letter from a
superior in your religious group).
I have done jury service in the last 2 years (No
explanation or proof is needed).
I have been excused from jury service for a period
that has not yet ended (Explain your reason below and
if possible attach proof, like a letter from the court).
In the last 5 years, I have been sentenced to
imprisonment or home detention for 3 months or
more (If you are on home detention, please give us a
letter from your Probation Officer. No explanation or proof
is needed if you have been imprisoned in the last 5 years).
I have been sentenced to imprisonment for 3 years
or more, or to preventive detention (No explanation or
proof is needed).
My job mades me ineligible to be on a jury (People in
certain jobs are not allowed to serve on a jury (section 8,
Juries Act 1981), like a job with the Department of
Corrections. Please explain your reasons below and
attach proof, like a business card or letter from a
manager).
Other personal circumstances (Please explain your
reason and attach proof to show why it would be very hard
for you to do jury service).
Reason (like ‘I am not able to do jury service because of a severe health condition. Copy of medical certificate
attached’). You can attach an extra page if needed.
Please sign and date the form
Signature Date
Send in your form
Complete, sign and print the form. Attach proof of your situation. You can post it to the District or High Court that summoned
you for jury service using the postage paid envelope included in your jury summons pack or scan and email the form. You will get a
letter from the court within 7 working days of the court getting this form.
If you need help please call 0800 268 787 or visit justice.govt.nz/jury-service.
click to sign
signature
click to edit
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