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Affidavit Of Default Of Payment

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ONTARIO

Affidavit of Default of Payment

Superior Court of Justice

Form 20M Ont. Reg. No.: 258/98

Small Claims Court

Claim No.

Address

Phone Number

BETWEEN

Plaintiff(s)/Creditor(s)

and

Defendant(s)/Debtor(s)

My name is

(Full Name)

I live in

(Municipality and Province)

and I swear/affirm that the following is true:

1. In this action, I am the

plaintiff/creditor.

(Check

one box

representative of the plaintiff(s)/creditor(s)

only.)

(Name of plaintiff(s)/creditor(s))

2. To date, I have received from the defendant(s)/debtor(s) $

, the last payment being made

(Amount)

on or about

, 20

3. I make this affidavit in support of a request that:

the clerk of the court issue a Default Judgment (Form 11B) [R. 9.03(2)(c)]. The defendant(s)

(Name(s) of defendant(s))

failed to make payment in accordance with the proposed terms of payment in the Defence

(Form 9A) dated

, 20

and fifteen (15) days have passed since the

defendant was served with a Notice of Default of Payment (Form 20L) at the following address(es):

(Check

appropriate

box and

(Address(es) of defendant(s))

complete

paragraph.)

the clerk of the court issue a Default Judgment (Form 11B) [R. 9.03(7)]. The defendant(s)

(Name(s) of defendant(s))

failed to make payment in accordance with the terms of payment order

dated

, 20

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RSCC-20M-E (2014/01)

Affidavit Of Default Of Payment

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