Rule 6.11 Form 6.

12
Certificate of Substituted Service of Statutory Demand
Date of Statutory Demand
(a) Insert name, address
and descrition of erson
ma!in" t#e certificate
I (a)
state as follo$s%
(b) Insert date
(c) &ive articulars of t#e
stes ta!en $it# a vie$ to
servin" t#e demand and
$#y t#ey $ere ineffective
and if t#e creditor #as
ta!en advanta"e of Rule
6.'(') (advertisin") state
t#e means of t#e creditor(s
!no$led"e for t#e
uroses of t#at Rule and
t#e met#od by $#ic#, and
t#e date or dates on $#ic#,
t#e demand $as
advertised.
1. )#at on (b)
an attemt $as made to serve t#e demand on t#e above named debtor by (c)
2. )#at on (b)
substituted service of t#e demand $as effected in t#e follo$in" $ay%
'. )#at to t#e best of my !no$led"e, information and belief t#e demand $ill #ave come to t#e
attention of t#e above named debtor by (b)
(d) Delete $ords in * + if
no ac!no$led"ement of
service #as been received
(d) *,. )#at on (b)
t#e debtor ac!no$led"ed service of t#e demand by (e)
+
(e) &ive articulars of t#e
$ay in $#ic# t#e debtor
ac!no$led"ed service of
t#e demand
(f) Delete as alicable
-. . coy of t#e demand mar!ed /.0 (d) *and t#e ac!no$led"ement of service mar!ed /10+ (f)
*is+ *are+ e2#ibited #ereto.
Statement of Truth
I believe t#at t#e facts stated in t#is Certificate are true.
Full name 33333333333333333333333333333.
Signed3333333333333333333333333333333
Dated 3333333333333333333333333333333.