This file may not be suitable for users of assistive technology.
Request an accessible format.
If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email firstname.lastname@example.org.
Please tell us what format you need. It will help us if you say what assistive technology you use.
You must get the form sealed by the court.
Include a copy of the affidavit or witness statement when you return the form, and a cheque for the payment.
The court may send this form and the documents directly to the Court Funds Office without a cheque. If that happens, CFO will send you a different form so you can pay the money in.