FORM E

(Rule 11)

20.... No.

IN THE SUPREME COURT OF NEWFOUNDLAND AND LABRADOR — COURT OF APPEAL

IN THE MATTER OF

(name of appellant) who was

convicted at

(name of town/city) in the Province

of Newfoundland and Labrador

by Judge

CERTIFICATE OF COURT REPORTER

I, (name of court reporter or supervisor of court reporters’ office) , hereby certify that the court reporters’ office received the within request for transcript on the day of , 20 and acknowledge that, on completion of preparation of same shall cause the original and copies to be delivered, provided or forwarded as requested.

(Supervisor or court reporter)