FORM 4C

COVERING PAGE

File No.

THE KING'S BENCH

Centre

BETWEEN:

(name)

plaintiff,

(or applicant or petitioner)

- and -

(name)

defendant

(or respondent)

(Title of Document)

(Where the document is an affidavit, the title shall include the deponent's name and the date the affidavit was sworn or affirmed).

(Where the document is a notice of motion, notice of application or notice of appeal, the title shall include the hearing date).

(Where there are more than two parties a short title showing the names of the first party on each side followed by the words "and others" may be used).

(Name, address and telephone number of the lawyer who has conduct of the proceeding or, where the party acts in person, the party's name and address of service including postal code and telephone number)