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FLR-6B-E (2016/04)
ONTARIO
Court File Number
(Name of court)
at
Court office address
Form 6B: Affidavit of Service
sworn/affirmed
Applicant(s)
Full legal name & address for service — street & number, municipality,
postal code, telephone & fax numbers and e-mail address (if any).
Lawyer’s name & address — street & number, municipality, postal
code, telephone & fax numbers and e-mail address (if any).
Respondent(s)
Full legal name & address for service — street & number, municipality,
postal code, telephone & fax numbers and e-mail address (if any).
Lawyer’s name & address — street & number, municipality, postal
code, telephone & fax numbers and e-mail address (if any).
My name is (full legal name)
I live in (municipality & province)
and I swear/affirm that the following is true:
1. On (date)
,
at (time)
, I served (name of person to be served)
with the following document(s) in this case:
List the
documents
served
Name of document Author (if applicable)
Date when document signed, issued,
sworn, etc.
NOTE: You can leave out any part of this form that is not applicable.
2. I served the documents mentioned in paragraph 1 by:
Check one
box only and
go to
indicated
paragraph.
special service. (Go to paragraph 3 below if you used special service.)
mail. (Go to paragraph 4 if you used mailed service.)
same day courier. (Go to paragraph 5 if you used courier.)
next day courier. (Go to paragraph 5 if you used courier.)
deposit at a document exchange. (Go to paragraph 6 if you used a document exchange.)
an electronic document exchange. (Go to paragraph 7 if you used an electronic document exchange.)
fax. (Go to paragraph 8 if you used fax.)
email. (Go to paragraph 9 if you used email.)
substituted service or advertisement. (Go to paragraph 10 if you used substituted service or advertisement.)
Page 2 of 3FLR-6B-E (2016/04)
Form 6B: Affidavit of Service
sworn/affirmed
(page 2)
Court File Number
3. I carried out special service of the document(s) on the person named in paragraph 1 at (place or address)
by:
Check one
box only.
Strike out
paragraphs 4
to 10 and go
to paragraph
11.
leaving a copy with the person.
leaving a copy with (name)
who is a lawyer who accepted service in writing on a copy of the document.
who is the person’s lawyer of record.
who is the (office or position)
of the corporation named in paragraph 1.
mailing a copy to the person together with a prepaid return postcard in Form 6 in an envelope bearing the
sender’s return address. This postcard, in which receipt of the document(s) is acknowledged, was returned and
is attached to this affidavit.
leaving a copy in a sealed envelope addressed to the person at the person’s place of residence with
(name)
who provided me with identification to show that he/she was an adult person residing at the same address and
by mailing another copy of the same document(s) on the same or following day to the person named in
paragraph 1 at that place of residence.
other (Specify. See rule 6 for details.)
4. I mailed the document(s) to be served by addressing the covering envelope to the person named in paragraph 1 at:
(Set out address.)
which is the address
Check appropriate
paragraph and strike
out paragraphs 3, 5, 6,
7, 8, 9 and 10.
of the person’s place of business.
of a lawyer who accepted service on the person’s behalf.
of the person’s lawyer of record.
of the person’s home.
on the document most recently filed in court by the person.
other (Specify.)
5.
The document(s) to be served was/were placed in an envelope that was picked up at
on
(date)
by (name of courier service)
a private courier service, a copy of whose receipt is attached to this affidavit. The envelope was addressed to the person
named in paragraph 1 at: (Set out address.)
which is the address
Check appropriate
paragraph and strike
out paragraphs 3, 4, 6,
7, 8, 9 and 10.
of the person’s place of business.
of a lawyer who accepted service on the person’s behalf.
of the person’s lawyer of record.
of the person’s home.
on the document most recently filed in court by the person.
other (Specify.)
a.m./p.m.
Page 3 of 3FLR-6B-E (2016/04)
Form 6B: Affidavit of Service
sworn/affirmed
(page 3)
Court File Number
6. The document(s) was/were deposited at a document exchange. The exchange’s date stamp on the attached copy shows the
date of deposit. (Strike out paragraphs 3, 4, 5, 7, 8, 9, 10 and 13.)
7. The documents were served through an electronic document exchange. The record of service from the exchange is attached
to this affidavit. (Strike out paragraphs 3, 4, 5, 6, 8, 9, 10 and 13.)
8. The document(s) to be served was/were faxed. The fax confirmation is attached to this affidavit. (Strike out paragraphs 3, 4, 5,
6, 7, 9, 10 and 13.)
9. The documents were served by email. Attached to this Affidavit is a copy of the email that the document was attached to.
(Strike out paragraphs 3, 4, 5, 6, 7, 8, 10 and 13.)
10.
An order of this court made on (date)
allowed
substituted service.
service by advertisement. (Attach advertisement.)
The order was carried out as follows: (Give details. Then go to paragraph 13 if you had to travel to serve substitutionally or by
advertisement.)
11. My relationship to, or affiliation with, any party in this case is as follows:
12. I am at least 18 years of age.
13. To serve the document(s), I had to travel
kilometres. My fee for service of the document(s) is
$
including travel.
Sworn/Affirmed before me at
municipality
in
province, state or country
on
date Commissioner for taking affidavits
(Type or print name below if signature is illegible.)
Signature
(This form is to be signed in front of a
lawyer, justice of the peace, notary public
or commissioner for taking affidavits.)
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