Application to Appeal in Forma Pauperism (O.44, R.1.)

(Title)

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 ........19...........

(Signed.)

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.