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(Name of Appellant or Applicant, as the case may be)
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The (appellant, applicant or respondent, as the case may be) has appointed (name) as counsel to provide limited-scope representation in this proceeding.
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1 COUNSEL’S MANDATE
Counsel’s representation of the (appellant, applicant or respondent, as the case may be) is limited to the following aspects of the proceeding: (Set out the scope of the mandate, including the subject matter and any scheduled appearances.)
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2 DESIGNATION FOR SERVICE OF DOCUMENTS
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□ SERVICE ON PARTY (Service of documents related to counsel’s mandate is to be made on the appellant, applicant or respondent, as the case may be.)
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3 DECLARATIONS
The undersigned counsel and the (appellant, applicant or respondent, as the case may be) each declare that this notice accurately describes the counsel’s mandate and the arrangements for the service of documents related to that mandate.
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(Signature of appellant, applicant or respondent, as the case may be)
(Name, address, telephone and fax numbers and email address of appellant, applicant or respondent, as the case may be)
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