Form 19D
Courts of Justice Act
REQUISITION FOR DEFAULT JUDGMENT
(General heading)
REQUISITION FOR DEFAULT JUDGMENT
TO THE LOCAL REGISTRAR AT (place)
(Where the defendant has not been noted in default, begin with: I REQUIRE you to note the defendant (name) in default in this action on the ground that (state nature of default).)
I REQUIRE default judgment to be signed against the defendant (name).
Default judgement may properly be signed in this action because the claim is for:
[ ] a debt or liquidated demand in money
[ ] recovery of possession of land
[ ] recovery of possession of personal property
[ ] foreclosure, sale or redemption of a mortgage
(Debt or liquidated demand)
[ ] There has been no payment on account of the claim since the statement of claim was issued. (Complete Parts B and C.)
OR
[ ] The following payments have been made on account of the claim since the statement of claim was issued. (Complete Parts A and C.)
PART A — PAYMENT(S) RECEIVED BY PLAINTIFF
(Complete this part only where part payment of the claim has been received. Where no payment has been received on account of the claim, omit this part and complete Part B.)
1. Principal
Principal sum claimed in statement of claim (without interest) $ .........................
Date of Payment 
Amount of Payment 
Payment Amount 
Applied to Interest 
Principal Sum Owing 


TOTAL 

$......................... 
$......................... 
$......................... 
A $......................... 
2. Prejudgment interest
(Under section 128 of the Courts of Justice Act, judgment may be obtained for prejudgment interest from the date the cause of action arose, if claimed in the statement of claim.)
Date on which statement of claim was issued ..................................................
Date from which prejudgment interest is claimed ..................................................
The plaintiff is entitled to prejudgment interest on the claim, calculated as follows:
(Calculate simple interest only unless an agreement relied on in the statement of claim specifies otherwise. Calculate interest on the principal sum owing from the date of the last payment. To calculate the interest amount, count the number of days since the last payment, multiply that number by the annual rate of interest, multiply the result by the principal sum owing and divide by 365.)
Principal 
Start Date 
End Date 
Number of Days 
Rate 
Interest Amount 

(The last End Date should be the date judgment is signed.)
TOTAL B 
$......................... 


Principal Sum Owing (Total A above) 
$......................... 

Total Interest Amount (Total B above) 
$......................... 

SIGN JUDGMENT FOR 
$......................... 
PART B — NO PAYMENT RECEIVED BY PLAINTIFF
(Complete this part only where no payment has been received on account of the claim.)
1. Principal
Principal sum claimed in statement of claim (without interest) A $ .........................
2. Prejudgment interest
(Under section 128 of the Courts of Justice Act, judgment may be obtained for prejudgment interest from the date the cause of action arose, if claimed in the statement of claim.)
Date on which statement of claim was issued ..................................................
Date from which prejudgment interest is claimed ..................................................
The plaintiff is entitled to prejudgment interest on the claim, calculated as follows:
(Calculate simple interest only unless an agreement relied on in the statement of claim specifies otherwise. To calculate the interest amount, count the number of days and multiply that number by the annual rate of interest, multiply the result by the principal sum owing and divide by 365.)
Principal 
Start Date 
End Date 
Number of Days 
Rate 
Interest Amount 

TOTAL B 
$......................... 


Principal Sum Owing (Total A above) 
$......................... 

Total Interest Amount (Total B above) 
$......................... 

SIGN JUDGMENT FOR 
$......................... 
PART C — POSTJUDGMENT INTEREST AND COSTS
1. Postjudgment interest
The plaintiff is entitled to postjudgment interest at the rate of ......................... per cent per year,
[ ] under the Courts of Justice Act, as claimed in the statement of claim.
OR
[ ] in accordance with the claim made in the statement of claim.
2. Costs
The plaintiff wishes costs to be,
[ ] fixed by the local registrar.
OR
[ ] assessed by an assessment officer.
Date 
......................................................................  ........................................................................................  
(Signature of plaintiff’s solicitor or plaintiff) 

(Name, address and telephone number of plaintiff’s solicitor or plaintiff) 
RCPE 19D (November 1, 2005)