Affidavit of True Likeness (Photograph)

AFFIDAVIT OF TRUE LIKENESS

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

1. The photograph attached to this affidavit and initialled by me is a true likeness of ______.

2. I know ______ as follows: ______.

3. I make this affidavit for the following purpose: ______.

I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.

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

_______________________________ _______________________________

A Commissioner for taking Affidavits Signature of Declarant