FORM 10

PROTEST BY A JUSTICE OF THE PEACE (WHERE THERE IS NO NOTARY) FOR NON-ACCEPTANCE OF A BILL, OR NON-PAYMENT OF A BILL OR NOTE

(Copy of Bill or Note and Endorsements)

On this .............. day of ............., in the year ......, I, N.O., one of Her Majesty’s justices of the peace for the District (or County, etc.), of ...................., in the Province of ...................., dwelling at (or near) the village of ...................., in the said District, there being no practising notary public at or near the said village (or any other legal cause), did, at the request of .................... and in the presence of .................... well known unto me, exhibit the original (bill or note) whereof a true copy is above written unto P.Q., the (drawer, acceptor or promisor) thereof, personally (or at P.Q.'s residence, office or usual place of business) in ................ and speaking to P.Q. (or ..................), did demand (payment or acceptance) thereof, unto which demand (he or she) answered: “ .................... ”.

Wherefore I, the said justice of the peace, at the request aforesaid, have protested, and by these presents do protest against the (drawer and endorsers, promisor and endorsers or acceptor, drawer and endorsers) of the said (bill or note) and all other parties thereto and therein concerned, for all exchange, re-exchange, and all costs, damages and interest, present and to come, for want of (payment or acceptance) of the said (bill or note).

All of which is by these presents attested by the signature of the said (the witness) and by my hand and seal.

R.S., 1985, c. B-4, Sch.; 2000, c. 12, ss. 22 to 24.