FORM 76O

CONSENT TO ACT AS LITIGATION GUARDIAN

File No.

THE KING'S BENCH

Centre

BETWEEN:

claimant

- and -

defendant

CONSENT TO ACT AS LITIGATION GUARDIAN

I, [name of person consenting] , consent to act as litigation guardian for the [claimant or defendant] in this claim, , who is under disability as follows:

(check one)

[ ]	a minor, whose date of birth is [ day/month/year ]

[ ]	mentally incompetent or incapable of managing his or her affairs, not so declared.

I am ordinarily resident in Manitoba.

My relationship to the [specify claimant or defendant] is .

I have no interest in this action contrary to that of the [specify claimant or defendant] .

I acknowledge that I may be personally liable for any costs awarded against me or the claimant if I act as litigation guardian for the claimant.

Date

Signature of person consenting

Address and postal code