Form 6.03A
(rule 6.03(3))

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.)

Acknowledgement of Receipt

TO:  (insert name of person being served)

You are served by mail with the documents enclosed with this form in accordance with the Rules of the Supreme Court, 1986.

You are requested to sign the acknowledgement below and mail this form immediately after you receive it.  If you fail to do so, the documents may be served on you in another manner and you may have to pay the costs of service.

I ACKNOWLEDGE that I have received a copy of the following documents: (To be completed in advance by the sender of the documents.  Include sufficient particulars to identify each document.)

(signature of person served)