FORM 19E

REQUISITION FOR DEFAULT JUDGMENT

(General Heading — Form 4A)

REQUISITION FOR DEFAULT JUDGMENT

TO THE DEPUTY 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 judgment 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 chattels

[ ]	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.

(or)

[ ]	The following payments have been made on account of the claim since the statement of claim was issued:

Date	Amount	$

TOTAL:	$

(Interest) The plaintiff is entitled to prejudgment interest in the claim, calculated as follows:

Principal	Start	End	Number	Interest

Sum	Date	Date	of Days	Rate	Amount

$

TOTAL:	$

(Where applicable, add: The plaintiff is entitled to postjudgment interest at the rate of (as set out in the statement of claim).

A default judgment may include prejudgment interest, or bear postjudgment interest at a rate other than at the postjudgment rate as provided in section 78 of the Act, only if it is pleaded and claimed in the statement of claim.

THE PLAINTIFF WISHES COSTS

[ ]	due to special circumstances, to be assessed by an assessment officer.

(or)

[ ]	to be fixed by the registrar:

Costs	Disbursements

Pleadings	$	$

Other steps before judgment

(e.g. motion for substitutional service, etc.)	$	$

Default Judgment	$	$

Totals	$	$

(Date)	(Signature of plaintiff's lawyer or plaintiff)

TOTAL COSTS AND DISBURSEMENTS ARE HEREBY FIXED AT:

Costs:	$

Disbursements:	$

Total:	$

(Date)

Registrar