Rules of the Supreme Court of Canada

I, (name of deponent), (profession of deponent), of (place), (province or territory), MAKE OATH AND SAY AS FOLLOWS:

THAT on the (date) day of (month), (year), I did serve (name of person(s) served) with a true copy of the (identify document(s) served) by (list the method or methods of service used)

• (a) personal service;

• (b) ordinary mail;

• (c) registered or certified mail or courier (annex a post office receipt, a receipt card bearing the signature of the person served or a copy of the tracking results of the courier service that indicates the status of the delivery of the document);

• (d) fax transmission (annex a copy of the cover page referred to in subrule 20(3) and a transmission slip that confirms the date and time of transmission);

• (e) email (annex a copy of the email referred to in subrule 20(3.1) and a copy of the read receipt, the delivery receipt or the confirmation by the party served that service was effected electronically); or

• (f) leaving a copy with the party’s counsel or agent or with an employee in the office of the counsel or agent.

Sworn (or Affirmed) before me at

the (City, Town, etc.) of (name) in the (Province or Territory) of (name), this day of , 20.

A Commissioner of Oaths

(Signature of deponent)