Affidavit Motion For Payment Out Of Court Page 2
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1
2FORM 4B
PAGE 2
Claim No.
I believe that this money should be paid out of court for the following reasons:
Set out your reasons in numbered paragraphs.
If more space is required, attach and initial extra pages
Sworn/Affirmed before me at
(Municipality)
in
(Province, state or country)
Signature
on
, 20
(This form is to be signed in front of a lawyer, justice of
Commissioner for taking affidavits
the peace, notary public or commissioner for taking
affidavits.)
(Type or print name below if signature is
illegible.)
WARNING:
IT IS AN OFFENCE UNDER THE CRIMINAL CODE TO KNOWINGLY SWEAR OR AFFIRM A FALSE AFFIDAVIT.
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RSCC-4B-E (2014/01)
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