Author: Dupont, Celine
Company: Courts Administration Service

Form IR-4 (Subrule 20(1))

Court File No.
FEDERAL COURT OF APPEAL
Between:
Appellant
(Applicant (or Respondent) in the Federal Court)
and
(name)
Respondent
(Applicant (or Respondent) in the Federal Court)

Notice of Appeal

THE APPELLANT (name) appeals from the judgment of the Honourable (name of judge) of the Federal Court, delivered on (date).
The following serious question(s) of general importance was (were) certified:
(Set out the question(s) certified.)
The question(s) was (were) certified under:
(Select the appropriate provision.)
•	[ ] SECTION 10.7 OF THE CITIZENSHIP ACT;
•	[ ] PARAGRAPH 22.2(d) OF THE CITIZENSHIP ACT; or
•	[ ] PARAGRAPH 74(d) OF THE IMMIGRATION AND REFUGEE PROTECTION ACT.
The appellant seeks the following relief on the determination of the question(s) under section 52 of the Federal Courts Act:
(Set out the relief sought, with reference to the specific provisions in section 52 of the Federal Courts Act relied on.)
The appellant requests that this appeal be heard at (place), in the (English and/or French) language.

Dated at , this  of , 20 .
(Name, address and telephone number of appellant’s solicitor)

TO: 
(Name and address of respondent’s solicitor, or respondent if acting in person)