Form 57A

Courts of Justice Act

BILL OF COSTS

(General heading)

BILL OF COSTS

AMOUNTS CLAIMED FOR FEES AND DISBURSEMENTS

(Following the items set out in Tariff A, itemize the claim for fees and disbursements.  Indicate the names of the lawyers, students-at-law and law clerks who provided services in connection with each item.

In support of the claim for fees, attach copies of the dockets or other evidence.

In support of the claim for disbursements, attach copies of invoices or other evidence.)

STATEMENT OF EXPERIENCE

A claim for fees is being made with respect to the following lawyers:

Name of lawyer

Years of experience

TO: (name and address of lawyer or party)

RCP-E 57A (November 1, 2005)