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| | LETTER OF REQUEST FOR EXAMINATION OF WITNESS OUT OF JURISDICTION/PERMISSION FOR EVIDENCE TO BE GIVEN BY LIVE VIDEO LINK OR LIVE TELEVISION LINK BY WITNESS OUT OF JURISDICTION |
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| | Central Authority of the Requested State |
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| | Person to whom the executed request is to be returned |
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| | Specification of the date by which the requesting authority requires receipt of the response to the Letter of Request |
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| | | To the Competent Authority of |
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| | | Names of the case and any identifying number |
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| | | Names and addresses of the parties and their representatives (including representatives in the Requested State*) |
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| | | Nature of the proceedings (divorce, paternity, breach of contract, product liability, etc.) |
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| | | Summary of defence and counterclaim* |
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| | | Other necessary information or documents* |
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| | | Evidence to be obtained or other judicial act to be performed |
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| | | Purpose of the evidence or judicial act sought |
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| | Identity and address of any person to be examined* |
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| | Questions to be put to the persons to be examined or statement of the subject matter about which they are to be examined* |
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| | Documents or other property to be inspected* |
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| | Any requirement that the evidence be given on oath or affirmation and any special form to be used* |
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| | Special methods or procedure to be followed (e.g., oral or in writing, verbatim transcript or summary, cross-examination, etc.)* |
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| | Request for notification of the time and place for the execution of the Request and identity and address of any person to be notified* |
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| | Request for attendance or participation of judicial personnel of the requesting authority at the execution of the Letter of Request* |
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| | Specification of privilege or duty to refuse to give evidence under the law of the Requesting State* |
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| | The fees and costs incurred which are reimbursable will be borne by* |
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| # This form requires sealing by the Court and the signature of the Registrar. |
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| (*Omit if not applicable) |
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| _______________________”; |
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