Form II—Notice of representation (counsel of record)

File number

Subject matter

Notice is given that the undersigned will appear as counsel* of record for

, a party before the Tribunal in the above-referenced matter.

*The term “counsel” includes any person who acts in a proceeding on behalf of a party.

Counsel of record information

Name of person, firm, company, foreign government or Canadian government institution:

Name

Address

City and province

Postal code

Telephone

Fax

I understand that checking this box constitutes my legally binding signature.

This box must be checked for the form to be considered complete.

Dated at

this

day of