Claim Form -Canada Superior Court. Province Of Quebec, Montreal. (Page 3 of 4) in pdf

Claim Form -Canada Superior Court. Province Of Quebec, Montreal. Page 3

I acknowledge that legal fees such as lawyers’ fees are covered proportionally by all members, and that my claim is reduced accordingly by the

Claims Administrator.

My claim should be supported by the SHQ Subsidy calculation form(s). In the event that I cannot provide the said document(s), I authorize the

Defendant to check the accuracy of information relating to my claim. I understand the importance of providing full and detailed information in

this Claim form.

I understand that the Claims Administrator must receive my claim before March, 12

2016.

I understand that the time limit for filing a contestation relating to the Claims Administrator’s decision is March, 25

2016.

I understand that claim contests will be heard by the Court on April, 4

2016. If I do not contest in front of the Cour or if I cash the check written

to my name, I thereby give total, final and complete receipt to the Defendant of any sum that may be due to me in regard of the facts in trial.

I understand that my claim form may be subject to audit, verification and Court review.

All of the facts alleged herein are true.

SIGNED BY MYSELF at

, this _____ day of _________ 20____

(Town)

(Date)

(Signature)

(You MUST sign this declaration before a Commissioner for Oaths)

Solemnly declared before me at ________________ this _____ day of _________ 20_____

Commissioner for Oaths

(You can find a Commissioner for Oaths in financial institutions, town halls, court houses or on the internet:

)

Claim Form -Canada Superior Court. Province Of Quebec, Montreal. Page 3