Author: Dupont, Celine
Company: Courts Administration Service

FORM 171ARule 171
Statement of Claim

(General Heading — Use Form 66)
(Court seal)

Statement of Claim

TO THE DEFENDANT:
A LEGAL PROCEEDING HAS BEEN COMMENCED AGAINST YOU by the Plaintiff. The claim made against you is set out in the following pages.
IF YOU WISH TO DEFEND THIS PROCEEDING, you or a solicitor acting for you are required to prepare a statement of defence in Form 171B prescribed by the Federal Courts Rules, serve it on the plaintiff’s solicitor or, if the plaintiff does not have a solicitor, serve it on the plaintiff, and file it, with proof of service, at a local office of this Court
WITHIN 30 DAYS after the day on which this statement of claim is served on you, if you are served in Canada or the United States; or
WITHIN 60 DAYS after the day on which this statement of claim is served on you, if you are served outside Canada and the United States.
TEN ADDITIONAL DAYS are provided for the filing and service of the statement of defence if you or a solicitor acting for you serves and files a notice of intention to respond in Form 204.1 prescribed by the Federal Courts Rules.
Copies of the Federal Courts Rules, information concerning the local offices of the Court and other necessary information may be obtained on request to the Administrator of this Court at Ottawa (telephone 613-992-4238) or at any local office.
IF YOU FAIL TO DEFEND THIS PROCEEDING, judgment may be given against you in your absence and without further notice to you.
(Date)
Issued by: 
(Registry Officer) 
Address of local office: 
TO: (Name and address of each defendant)
(Separate page)
Claim

•	1 The plaintiff claims: (State here the precise relief claimed.)
(In consecutively numbered paragraphs, set out each allegation of material fact relied on to substantiate the claim.)

The plaintiff proposes that this action be tried at (place).
(Date)

(Signature of solicitor or plaintiff)
(Name, address and telephone and fax numbers of solicitor or plaintiff)

SOR/2021-150, s. 12