Agent Form

TATC File No. _______________________

TC/CTA File No. __________________

In the matter of the review hearing between:

___________________, Applicant

and

_________________, Respondent

Notice of appointment of an agent pursuant to

subsection 15(3) of the Transportation Appeal Tribunal of Canada Act

I, the undersigned,_________________,

residing at _________________________, in the city of _________________, province of____________, postal code _______, telephone ( ) ______________ ,

BEING DULY AUTHORIZED, declare that ____________________ is a party in the above matter, and hereby appoints as its agent for purposes of all proceedings before the Tribunal in the present instance, including appearances and service of documents:

name of agent:______________________ company:_______________________, address:_____________________________________, in the city of ____________________, province of ___________________, postal code _____________, telephone (      ) _______________ .

This appointment shall continue in force until a notice of cancellation of appointment or change of agent is filed by ________________________ with the Tribunal.

signed at____________________ date:___________________

signature: ______________________

Notice of acceptance of appointment as agent

pursuant to subsection 15(3) of the Transportation Appeal Tribunal of Canada Act

I, the undersigned, ______________________, hereby accept this appointment as agent for

________________________ in these proceedings. This appointment shall continue until a notice of

withdrawal is filed by me with the tribunal.

signed at______________________ date:_____________________

signature:______________________________ AGENT