Consent To Act As Litigation Guardian

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ONTARIO
Consent to Act as Litigation Guardian
Superior Court of Justice
Form 4A Ont. Reg. No.: 258/98
Small Claims Court
Claim No.
Address
Phone Number
BETWEEN
Plaintiff(s)
and
Defendant(s)
My name is
Name
And I live at
Street and number
City, province, postal code
Phone number and fax number
1. I consent to act as litigation guardian in this action for the
plaintiff, named
(Name of plaintiff)
(Check one
and I acknowledge that I may be personally responsible for any costs awarded against me or against this person.
box only.)
defendant, named
.
(Name of defendant)
2. The above-named person is under the following disability:
a minor whose birth date is
.
(State date of birth of minor)
(Check
appropriate
mentally incapable within the meaning of Section 6 or Section 45 of the Substitute Decisions Act, 1992 in respect
box(es).)
of an issue in a proceeding.
an absentee within the meaning of the Absentees Act.
3. My relationship to the person under disability is
(State your relationship to the person under disability.)
Les formules des tribunaux sont affichées en anglais et en français sur le site
Visitez ce site pour des renseignements sur des formats
accessibles.
RSCC-4A-E (2014/01)

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