(Title)A.B.,
the above named plaintiff, states as follows:-1. 1.On the day of 19,
he lent the defendant rupees repayable on the day of2. 2.The defendant has
not paid the same, except rupees paid on the day of 19.[If
the plaintiff claims exemption from any law of limitation, say:-]1.2.3. The plaintiff was a
minor [or insane] from the day of till the day of4. [Facts showing when
the cause of action arose and that the Court has jurisdiction.]5. The value of the
subject-manner of the suit of the suit for the purpose of jurisdiction is
rupees and for the purpose of court-fees is rupees.6. The plaintiff claims
rupees, with interest at percent from the day of 19.