Form 5.03A
(rule 5.03)

File number: 20____ ____ G __________

IN THE SUPREME COURT OF NEWFOUNDLAND AND LABRADOR
GENERAL DIVISION

BETWEEN:			
	(Plaintiff’s name)	PLAINTIFF	
			
AND:			
			
	(Defendant’s name)	DEFENDANT	
			
(Modify title of proceeding as necessary.)

Statement of Claim

1. (Set out the material facts, in numbered paragraphs.)
	
2. The plaintiff therefore seeks the following relief (set out the relief, remedy, or order you are requesting).

DATED at _____________ (city/town), _______________________ (province or, if outside of Canada, country), on the ________ (day) of __________________ (month), ________ (year). 

__________________________
(Signature)
Plaintiff/Solicitor for Plaintiff 

Whose address for service is: 
(Insert address for service)
Newfoundland and Labrador
To: 	(Defendant(s) or the solicitor(s) 
for the defendant(s))
	(Insert address)

ISSUED at 					  (city/town) in the Province of Newfoundland and Labrador this 		 (day) of 			 (month), 		 (year).

(Affix seal of the court)

(signature)
Registrar/Registry Clerk

File number: 20____ ____ G __________

IN THE SUPREME COURT OF NEWFOUNDLAND AND LABRADOR
GENERAL DIVISION

BETWEEN:			
	(Plaintiff’s name)	PLAINTIFF	
			
AND:			
			
	(Defendant’s name)	DEFENDANT	
			
(Modify title of proceeding as necessary.)

Notice to Defendant(s)

You are hereby notified that the plaintiff(s) may enter judgment in accordance with the statement of claim or such order as, according to the practice of the Court, the plaintiff is entitled to, without any further notice to you unless within _________ days, after service hereof upon you, you cause to be filed with the Supreme Court of Newfoundland and Labrador at _______________________ a defence and unless within the same time a copy of your defence is served upon the plaintiff(s) or the plaintiff’s solicitor(s) at the plaintiff’s solicitor(s) stated address(es) for service. 

Provided that if the claim is for a debt or other liquidated demand and you pay the amount claimed in the statement of claim and the sum of $___________ (or such sum as may be allowed on taxation) for costs to the plaintiff(s) or the plaintiff’s solicitor(s) within _________days from the service of this notice upon you, then this proceeding will be stayed. 

To: 	(Defendant(s) or the solicitor(s) 
for the defendant(s))
	(Insert address)