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. Canadian Radio-television and

Telecommunications Commission
Conseil de la radiodiffusion et des
télécommunications canadiennes
. FORM IV - AFFIDAVIT OF DISBURSEMENTS
. IN THE MATTER OF THE TAXATION OF COSTS AWARDED TO BY COSTS ORDER
. AFFIDAVIT
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The applicant's GST registration number is _________________ . [Insert a similar paragraph if a credit is available under the applicable provincial sales tax regime.]
I, ______________________________ of the ___________________________________ in the Province of ___________________ , make oath and say [or affirm]: 1. I am ____________________________ of the applicant, __________________________________ (the "applicant"), and as such have knowledge of the matters to which I hereinafter depose. 2. Attached to my affidavit as Exhibit A [is/are] _____ sheet(s) setting out the disbursement claims of _____________________________________ and the required evidence of disbursement [receipts and other supporting documentation as required under section 31 which [has/have] been prepared in accordance with sections 20 to 36 of the Legal Directorate's Guidelines for the Taxation of Costs, dated May 15, 1998. 3. To the best of my knowledge and belief, the disbursement claims of ______________________ __________________ submitted herewith, and all the documentation in support, represent disbursements incurred necessarily and reasonably for the purpose of the proceeding. 4. The disbursement claims submitted herewith are made in accordance with the Commission's determination set out in Cost Order Number _____________ and do not exceed the costs permitted therein. 5. [Where applicable] The applicant has submitted claims for meals both on a per diem basis and on the basis of individual meals. To the best of my knowledge and belief, these claims represent disbursements incurred for the purpose of this proceeding and do not lead to double recovery. 6. The applicant [has or will] receive(d) the following financial assistance in direct connection with its participation in the proceeding: ______________________________________ . 7. The applicant is entitled to a rebate in connection with the Federal Goods and Services Tax to the extent of _____ %, based on ___________________________________________________ .
SWORN [OR AFFIRMED] BEFORE ME at the [City, Town, etc.] of _____________________ in the [County, Regional Municipality, etc.] of ___________________________, in the Province of ___________________ on [date] ___________.
. COMMISSIONER for taking Affidavits [or as may be] . (Signature of Affiant)
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CRTC 46E (1999-02)
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version française disponible
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