Request For Clerk'S Order On Consent
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4ONTARIO
Superior Court of Justice
Request for Clerk’s Order on Consen
t
Form 11.2A Ont. Reg. No.: 258/98
Small Claims Court
Claim No.
Address
Phone Number
Plaintiff No. 1
Additional plaintiff(s) listed on attached Form 1A.
Last name, or name of company
First Name
Second Name
Also Known as
Address (street number, apt., unit)
City/Town
Province
Phone no.
Postal Code
Fax no.
Representative
LSUC #
Address (street number, apt., unit)
City/Town
Province
Phone no.
Postal Code
Fax no.
Defendant No. 1
Additional defendant(s) listed on attached Form 1A.
Last name, or name of company
First Name
Second Name
Also Known as
Address (street number, apt., unit)
City/Town
Province
Phone no.
Postal Code
Fax no.
Representative
LSUC no.
Address (street number, apt., unit)
City/Town
Province
Phone no.
Postal Code
Fax no.
NOTE:
This request must be signed by all parties and anyone being added, deleted or substituted.
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RSCC-11-2A-E (2014/01)
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