If the application for leave is granted, the applicant seeks the following relief by way
of a judicial review:
(set out the precise relief sought should leave be granted, including any
statutory provision or rule relied on)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If the application for leave is granted, the application for judicial review is to be
based on the following grounds:
(set out the grounds to be argued, including a reference to
any statutory provision or rule to be relied on)
1.
2.
3.
4.
5.
6.
□
□
The applicant: has
/ has not
received written reasons from the tribunal.
If the application for leave is granted, the applicant proposes that the application for
judicial review be heard at __________________________
in the
(insert City),
language.
______________
(English and/or French)
3