Form 7.20A
(rule 7.20)

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.)

Application for costs exemption

TO THE SUPREME COURT OF NEWFOUNDLAND AND LABRADOR OR ONE OF THE JUDGES THEREOF:

If you are a party to a proceeding in the Court, complete paragraph 1.
	
If you tick that you are in receipt of income support, please attach proof of this to this application.
	The application of (insert applicant’s name), the Applicant herein says,

1.	I am (please tick one box below)

	in receipt of income support under the Income and Employment Support Act . 

	not in receipt of income support. 

If you stated that you are not in receipt of income support, complete paragraphs 2-3.
	
Please attach documentary proof of your income (ex. notices of assessment from CRA)
	2. 	My annual income for the last three years was:

	$_______________________ (Year: ____________)

	$_______________________ (Year: ____________)

	$_______________________ (Year: ____________)

Please attach documentary proof of your monthly expenses (ex. bills)	3.	My monthly expenses are:

	(List your monthly expenses here.)

	

For all applications, complete paragraph 4-6
	
	4. 	The nature of my claim/defense/appeal/etc. is:

(Describe the nature of your claim, defense, appeal, etc. here.)
	
	5. 	Please set out any other relevant information:

(Set out any other relevant information here.)
	
	6. 	The applicant therefore applies for an order that the applicant be exempt from the payment of any order for costs in the above noted proceeding.

If you have not attached documentary proof as required above, your application may be denied on that basis. 

STATEMENT OF TRUTH

The contents of the within application are true to the best of my information and belief.

SWORN/AFFIRMED 
at _____________________ (city/town), ________________________ (province or, if outside of Canada, country), on the _____(day) of ____________________ (month), ______ (year), before me 			
_____________________	
(signature)
Commissioner, notary public, etc. 

_____________________	
(signature of applicant)

	Whose address for service is: 
(Insert address for service)
	Newfoundland and Labrador

To:	(Each other party/solicitor for the party)
(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	
			
AND:			
			
	__________________________________	DEFENDANT	
			
(Modify as appropriate to match title of proceeding.)

Notice to the Respondent(s)

You are hereby notified that you must attend before a judge presiding in chambers at the Courthouse at ___________________, Newfoundland and Labrador, on __________ the _________ day of __________________, _______ at _________ to set a date for the hearing of the application in the above noted matter. 

AND FURTHER TAKE NOTICE that the judge may make an order in favour of the applicant in your absence and without further notice unless you or your solicitor appear at the time and place noted above. 

To: 	(Each other party/solicitor for the party)
	(insert address)