Consent To Act As Litigation Guardian Page 2
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1
2FORM 4A
PAGE 2
Claim No.
4. I have no interest in this action contrary to that of the person under disability.
5. I am
(Check one
represented and have given written authority to
box only.)
(Name of representative with authority to act in this proceeding)
of
(Address for service)
(Phone number and fax number)
to act in this proceeding.
not represented by a representative.
, 20
(Signature of litigation guardian consenting)
(Signature of witness)
(Name of witness)
Note:
Within seven (7) calendar days of changing your address for service, notify the court and all other parties in
writing.
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RSCC-4A-E (2014/01)
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Parent category: Legal