Form 72A

Courts of Justice Act

notice of payment into court

(General heading)

notice of payment into court

The (identify party) paid into court on (date) the sum of $......................... under the offer to settle (or acceptance of offer) dated (date).

(Date)

(Name, address and telephone number of solicitor or party giving notice)

TO (Name and address of solicitor or party receiving notice)

RCP-E 72A (November 1, 2005)