CANADA

PROVINCE OF PRINCE EDWARD ISLAND

IN THE PRINCE EDWARD ISLAND COURT OF APPEAL No. S1-CA-

BETWEEN:

(Name of appellant)

APPELLANT

AND

(Name of respondent)

RESPONDENT

I, (full name) , presently residing at , in the (city/town/village) of , in the Province of , MAKE OATH AND SAY AS FOLLOWS:

• 1. 

  I am the appellant/respondent and personally know about the matters referred to in this Affidavit, except where they are based on information and belief, in which case I believe them to be true.
• 2. 

  I cannot afford a lawyer because of my financial circumstances.
  • (a) 

    my income last year was $
  • (b) 

    my present monthly expenses are $
  • (c) 

    my debts total $
  • (d) 

    all the things that I own have a value of $
• 3. 

  I am not able to present or respond to the appeal myself for the following reasons:

  

  

• 4. 

  I applied for legal aid but was refused on: (day) (month) (year).
• 5. 

  I hereby authorize legal aid to release to the Registrar a copy of any information or material I have provided to them in relation to my application for legal aid.
• 7. 

  The following are the main points to be argued in this appeal:

  

  

• 8. 

  My case is complex and I will need a lawyer to organize and present this appeal for the following reasons:

  

  

• 9. 

  In my opinion I have a good chance of succeeding on this appeal for the following reasons:

  

  

Sworn (or affirmed) before me at

, Province of

on (date)