Form 61C

Courts of Justice Act

appellant’s certificate

(General heading in accordance with Form 61B)

appellant’s certificate

The appellant certifies that the following evidence is required for the appeal, in the appellant’s opinion:

1.     Exhibits numbers .........................

2.     The affidavit evidence of (names of deponents)

3.     The oral evidence of (names of witnesses)

(Date)

(Name, address and telephone and fax numbers of appellant’s lawyer or appellant)

TO      (Name and address of respondent’s lawyer or respondent)

RCP-E 61C (November 1, 2005)