FORM 22A

SPECIAL CASE

(General Heading — Form 4A or 4B)

SPECIAL CASE

THE FOLLOWING CASE is stated for the opinion of the court:

1.	(Set out, in consecutively numbered paragraphs, the material facts of the case, as agreed on by the parties, that are necessary to enable the court to deterine the questions stated. Refer to and include a copy of any relevant documents).

THE QUESTIONS for the opinion of the court are:

1.	(Set out the questions in consecutively numbered paragraphs).

THE RELIEF SOUGHT on the determination of the questions stated is:

1.	(Set out the relief sought, as agreed on by the parties, in respect of each possible answer to each of the questions stated, in a form that could readily be incorporated into an order).

(Date)	(signatures of all lawyers or parties in the proceeding)

(names, addresses and telephone numbers of all lawyers or parties in the proceeding)