FORM No. 5 : AFFIDAVIT OF SERVICE (O. 5, r. 2).
I,
, a process-server, make oath and say that I served an office copy of the writ of summons in Action No.
of the
Registry, at (a)
on the
day of
, 19
, by leaving the same in the presence of
with the Defendant (b)
(c)
of
,for the Defendant
whom I did not find at his house or at his usual place of employment, the said
, being a (d)
of the said Defendant.
A duplicate of the document(s) served is attached hereto as an exhibit and is marked " A "
or
This affidavit is endorsed on a duplicate of the document served.
Signed and sworn before me
at
on the
day
(Signed)
of
19
Registrar.
(a) Town or village where service effected.
(b) Strike out the words " the Defendant," if inapplicable.
(c) Strike out to the end, if inapplicable.
(d) State his relationship to the Defendant for whom the writ is left.
Note.-The affidavit of service should be sworn within seven days after service.