In the District Court of

No.                       of 19            .

Between

A. B.,

Plaintiff,

and

C. D.,

Defendant.

Application by A.B., of                                  .

Let all persons concerned attend the Court at on the                       day of                                  19            , at the hour of            in the                       noon, on the hearing of an application whereby by the above-named applicant applies for (a)

The application is based on (b)

*The facts relied upon are as follows : (c)

or

*(The facts relied upon are set out in the accompanying affidavit of A.B. of                                  dated the                       day of                                  , 19            .)

This summons was taken out by the applicant in person (or by E.F., advocate for the applicant). Address for service

(Signed)                                 

Filed on the                       day of                                  19            .

Fixed for hearing on the                       day of                                  19            , at the hour of                       in the                       noon.

To (d)                                  .

Registrar.                      

(a) Set out order or direction applied for.

(b) Set out specific section of Law or specific Rule of Court.

(c) If the application is not required by the rules to be supported by affidavit, the facts relied upon should be stated in the application.

(d) State name and address of person to be served with the summons ; and on form filed in Court give names and addresses of every such person. * Strike out if not required.