When to ll in this form
• You are admitting all of the claim and you are asking for
time to pay; or
• You are admitting part of the claim. (You should also
complete form N9B).
How to ll in this form
Individual
• Tick the correct boxes and give as much information
as you can. Then sign and date the form. If necessary
provide details on a separate sheet add the claim number
and attach it to this form.
• Make your oer of payment in box 11 on the back of this
form. If you make no oer the claimant will decide how
much and when you should pay.
Organisation
• If you are not an individual, you should ensure you attach
a nancial statement showing your companies prot,
loss, assets and liabilities to support any oer of payment
made in box 11. Ensure you tick the correct box and
complete sections 1, 9 (if applicable) and 12. If you are a
Limited Company, the claimant is under no obligation to
accept your oer.
• You can get help to complete this form at any County
Court or Citizen Advice Bureau.
Where to send this form
• If you admit the claim in full
Send the completed form to the claimants address shown
on the claim form as one to which documents should be sent.
• If you admit only part of the claim
Send the form to the issuing court at the address given
on the claim form, together with the defence form (N9B).
How much of the claim do you admit?
I admit the full amount claimed as shown on
the claim form
or
I admit the amount of £
1 Personal/Organisation details
Surname/
Organisation
Forename
Mr Mrs Miss Ms
Married Single
Other
(specify)
Date of birth
D D M M Y Y Y Y
Address
Phone no.
2 Dependants (people you look after nancially)
Number of children in each age group
under 11 11-15 16-17 18 & over
Other dependants
(give details)
N9A Form of admission (specied amount) (04.14) © Crown copyright 2014
Admission (specied amount)
• You have a limited number of days to complete and
return this form
• Before completing this form, please read the notes
for guidance attached to the claim form
Name of court
Claim No.
Claimant
(including ref.)
Defendant
5 Residence
I live in
my own house lodgings
my jointly
owned house
council
accommodation
rented accommodation
4 Bank account and savings
I have a bank account
The account is in credit by £
The account is overdrawn by £
I have a savings or building society account
The amount in the account is £
3 Employment
I am employed as a
My employer is
Jobs other than main
job
(give details)
I am self employed as a
Annual turnover is £
I am not in arrears with my national insurance
contributions, income tax and VAT
I am in arrears and I owe £
Give details of:
(a) contracts and
other work in hand
(b) any sums due
for work done
I have been
unemployed for
years months
I am a pensioner
