Form 19D Requisition for Default Judgment



Court file no. 0123

ONTARIO

SUPERIOR COURT OF JUSTICE

B E T W E E N:

Capital Finance Ltd.

Plaintiff

And

FREDERICK ALEXANDER FLINTSTONE

Defendant

requisition for default judgment

to the local registrar at St. Catharines Courthouse 59 Church St. L2R 7N8

I REQUIRE you to note the defendant Frederick Alexander Flintstone in default in this action on the ground that the defendant has failed to deliver a statement of defence within the time provided for in the rules.

I REQUIRE default judgment to be signed against the defendant Frederick Alexander Flintstone

Default judgment may properly be signed in this action because the claim is for:

[X] a debt or liquidated demand in money

[ ] recovery of possession of land

[ ] recovery of possession of personal property

[ ] foreclosure, sale or redemption of a mortgage

(Debt or liquidated demand)

[X] There has been no payment on account of the claim since the statement of claim was issued.

(Complete Parts B and C.)

OR

[ ] The following payments have been made on account of the claim since the statement of claim was issued. (Complete Parts A and C.)

part a — payment(s) received by plaintiff

(Complete this part only where part payment of the claim has been received. Where no payment has been received on account of the claim, omit this part and complete Part B.)

1. Principal

Principal sum claimed in statement of claim (without interest) $

| | |Payment Amount Principal | | |

|Date of Payment |Amount of Payment | |Applied to Interest |Principal Sum Owing |

|total |$ |$ |$ |A $ |

| | | | | |

2. Prejudgment interest

(Under section 128 of the Courts of Justice Act, judgment may be obtained for prejudgment interest from the date the cause of action arose, if claimed in the statement of claim.)

Date on which statement of claim was issued

Date from which prejudgment interest is claimed

The plaintiff is entitled to prejudgment interest on the claim, calculated as follows:

(Calculate simple interest only unless an agreement relied on in the statement of claim specifies otherwise. Calculate interest on the principal sum owing from the date of the last payment. To calculate the interest amount, count the number of days since the last payment, multiply that number by the annual rate of interest, multiply the result by the principal sum owing and divide by 365.)

|Principal |Start Date |End Date |Number of Days |Rate |Interest Amount |

|Sum Owing | |(Date of Payment) | | | |

(The last End Date should be the date judgment is signed.)

| |TOTAL B $ |

|Principal Sum Owing (Total A above) | $ |

|Total Interest Amount (Total B above) | $ |

|SIGN JUDGMENT FOR | $ |

part B — NO payment received by plaintiff

(Complete this part only where no payment has been received on account of the claim.)

1. Principal

Principal sum claimed in statement of claim (without interest) A $ 50,000.00

2. Prejudgment interest

(Under section 128 of the Courts of Justice Act, judgment may be obtained for prejudgment interest from the date the cause of action arose, if claimed in the statement of claim.)

Date on which statement of claim was issued September 3, 2013

Date from which prejudgment interest is claimed August 1, 2013

The plaintiff is entitled to prejudgment interest on the claim, calculated as follows:

(Calculate simple interest only unless an agreement relied on in the statement of claim specifies otherwise. To calculate the interest amount, count the number of days and multiply that number by the annual rate of interest, multiply the result by the principal sum owing and divide by 365.)

|Principal |Start Date |End Date |Number of Days |Rate |Interest Amount |

|Sum Owing | | | | | |

| | |(Date of Payment) | | | |

| |TOTAL B $ 1,745.21 |

|Principal Sum Owing (Total A above) | $ 50,000.00 |

|Total Interest Amount (Total B above) | $ 1,745.21 |

|SIGN JUDGMENT FOR | $ 51,745.21 |

part c — postjudgment interest and costs

1. Postjudgment interest

The plaintiff is entitled to postjudgment interest at the rate of 12 per cent per year,

[ ] under the Courts of Justice Act, as claimed in the statement of claim.

OR

[X] in accordance with the claim made in the statement of claim.

2. Costs

The plaintiff wishes costs to be,

[X] fixed by the local registrar.

or

[ ] assessed by an assessment officer.

Date October 30, 2013 __________________________________________

Nancy Bellantino

Lawyer: Nancy Bellantino

1 Main Street,

Welland, ON, L3B 5S2

Bellantino and Drozdoski

Tel: (905) 736-4390

Fax: (905) 893-3949

Lawyer for the plaintiff

-----------------------

$50,000.00 July 31, 2013 October 30, 2013 91 14% $1,745.21

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