Page 64 - tmp

Claim No.

Section D

I object to the claimant issuing under this procedure My reasons

for objecting are:

Section E
I intend to rely on written evidence

My written evidence:
[ J is filed with this form

I will be filed within 14 days as agreed with the other party(ies). A copy of the written agreement is attached to this form

Section F

Full name of defendant
filing this acknowledgment

Section G

Signed

(To be signed by
you or by your
solicitor or
litigation friend)

Date

Give an
address to
which notices
about this case
can be sent to
you

63