SCHEDULE B
Form 1
I
N
C
J
— S
C
N THE
UNAVUT
OURT OF
USTICE
MALL
LAIMS
NOTICE OF CLAIM
File No. _________________
FROM (CLAIMANT) (Please print)
Name
Home phone No.
Address
Community
Work phone No.
Postal Code
Email address
Fax No.
Address for servic
e
TO (DEFENDANT) (Please print)
Name
Home phone No.
Address
Community
Work phone No.
Postal Code
Email address
Fax No.
AND TO (ADDITIONAL DEFENDANT) (Please print)
Name
Home phone No.
Address
Community
Work phone No.
Postal Code
Email address
Fax No.
TO THE DEFENDANT*
Attention: Please read the Notice on the back.
* ᐃᖅᑲᑐᕐᑕᐅᔪᒧᑦ: ᐅᖃᓕᒫᕐᓗᒋᑦ ᑐᓂᐊᓂ (ᐃᓄᒃᑎᑑᕐᑐᑦ).
* À L’ATTENTION DU DÉFENDEUR : Veuillez lire l’avis à l’endos.
T
C
$
(max. of $20,000)
HE
LAIMANT CLAIMS FROM YOU
(
$
)
(
)
.
AND THE COST OF THIS CLAIM
CURRENTLY
FOR THE REASON
S
SET OUT BELOW
Describe what happened (Use additional sheet of paper if necessary)
When and where did it happen?
(Day, month, year)
(Community)
The location of this trial should be:
(Community)
Yes
No
Is your claim for more than $20,000?
Yes
No
If yes, are you abandoning the amount over $20,000?**
** If you abandon part of your claim, you agree not to try to recover it in another small claim or other legal
proceedings.
Yes
No
Unknown
The Defendant understands the language of this claim.***
*** If the defendant does not understand the language of this claim, this may delay the proceedings.
___________________________________________________
_________________
Signature of Claimant
Date
_________________________
_______
______________
__
ISSUED at
, in Nunavut on the
day of
, 20
.
(Community)
_____________________________
Clerk of the Nunavut Court of Justice