RSCC-11A-E (2014/01)

ONTARIO Superior Court of Justice

Affidavit for Jurisdiction Form 11A Ont. Reg. No.: 258/98

Small Claims Court

Address

Phone Number

Claim No.

BETWEEN

Plaintiff(s)

and

Defendant(s)

My name is(Full name)

I live in(Municipality & province)

and I swear/affirm that the following is true:

Plaintiff

representative of the plaintiff

1. In this action, I am the

(Name of plaintiff(s))2. I make this affidavit in support of the plaintiffs request to note the defendant(s) in default, where all the defendants have been

or will be served outside the courts territorial division [R. 11.01 (3)].3. The plaintiff is entitled to proceed with this action in this territorial division because this is:

where the event (cause of action) took place.

where the defendant lives or carries on business.

the court nearest to the place where the defendant lives or carries on business [R. 6.01].

(Municipality)

in(Province, state or country)

Sworn/Affirmed before me at

, 20Commissioner for taking affidavits

(Type or print name below if signature is illegible.)

on

Signature (This form is to be signed in front of a lawyer,

justice of the peace, notary public or commissioner for taking affidavits.)

WARNING: IT IS AN OFFENCE UNDER THE CRIMINAL CODE TO KNOWINGLY SWEAR OR AFFIRM A FALSE AFFIDAVIT.

Les formules des tribunaux sont affiches en anglais et en franais sur le site www.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des formats accessibles.

Affidavit for Jurisdiction Form 11A

RSCC-11A-E (2014/01)

RSCC-11A-E (2014/01)

Affidavit for Jurisdiction Form 11A

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ONTARIOSuperior Court of Justice

Affidavit for Jurisdiction

Form 11A Ont. Reg. No.: 258/98

BETWEEN

and

My name is

I live in

and I swear/affirm that the following is true:

1. In this action, I am the

2. I make this affidavit in support of the plaintiffs request to note the defendant(s) in default, where all the defendants have been or will be served outside the courts territorial division [R. 11.01 (3)].

3. The plaintiff is entitled to proceed with this action in this territorial division because this is:

in

Sworn/Affirmed before me at

, 20

on

WARNING: IT IS AN OFFENCE UNDER THECRIMINAL CODE TO KNOWINGLY SWEAR OR AFFIRM A FALSE AFFIDAVIT.

Les formules des tribunaux sont affiches en anglais et en franais sur le sitewww.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des formats accessibles.

8.0.1291.1.339988.308172

Affidavit for Jurisdiction Form 11A Ont. Reg. No.: 258/98

Affidavit for Jurisdiction Form 11A Ont. Reg. No.: 258/98

MAG

CurrentPageNumber: Day Month: Small Claims Court: Address: Phone Number: Claim Number: Between. Plaintiff(s): and. Defendant(s): Commissioner for taking affidavits (Type or print name below if signature is illegible.): I live in. (Municipality & province): Plaintiff: representative of the plaintiff: where the event (cause of action) took place.: the court nearest to the place where the defendant lives or carries on business [R. 6.01].: Year: Signature (This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking affidavits.): Save Form: Print Form: Clear Form: