APPLICATION TO APPEAL IN FORMA PAUPERIS
(O .44, r. 1.)
I ______ the __________ above-named, present the accompanying memorandum of appeal from the decree in the above suit and apply to be allowed to appeal as a pauper.
Annexed is a full and true schedule of all the movable and immovable property belonging to me with the estimated value thereof.
Dated the _______ day of _______ 20____.
[Note:- Where the application is by the plaintiff he should state whether he applied and was allowed to sue in the Court of first instance as a pauper.]