Rules of the Supreme Court of Canada

I (name), (counsel or agent) for (name of applicant or appellant), hereby certify that

• (a) (state whether there is a sealing or confidentiality order in effect in the file from a lower court or the Court and whether any document filed includes information that is subject to a sealing or confidentiality order or that is classified as confidential by legislation);

• (b) (state whether there is, pursuant to an order or legislation, a ban on the publication of evidence or the names or identity of a party or witness and whether any document filed includes information that is subject to that ban); and

• (c) (state whether there is, pursuant to legislation, information that is subject to limitations on public access and whether any document filed includes information that is subject to those limitations).

Dated at (place and province or territory) this (date) day of (month), (year).

(Counsel or agent) for the (applicant or appellant)

(Signature)

ORIGINAL TO: THE REGISTRAR

COPIES TO: (Name, address and telephone number, and fax number and e-mail address (if any), of every party)

(Include a copy of any order or provision of applicable legislation. Any document that includes information listed in (a) shall be filed in a sealed envelope. If that document is required to be filed by these Rules, it shall be accompanied by a motion to seal, two redacted printed versions and one redacted electronic version of the document, if required — See Rule 19.1.)