Affidavit of Identity and Signature

AFFIDAVIT OF IDENTITY AND SIGNATURE

I, ______, of ______, in the Province of Ontario, MAKE OATH AND SAY that:

1. I am the person named above, born on ______, and my identity is confirmed by the following identification: ______.

2. The signature I provide below, in the presence of the commissioner, is my true and genuine signature.

3. I use this signature in connection with the following document or account: ______.

4. I make this affidavit to verify my identity and signature, for the following purpose: ______.

5. Specimen signature: _______________________________

SWORN / AFFIRMED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.

_______________________________ _______________________________

A Commissioner for taking Affidavits Signature of Deponent