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A sworn consent authorizing an organization to release your personal information or records to a named person or body — for medical, financial, school, or employment records. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Word files are editable. Review any changes carefully before signing or uploading.
Also known as
CONSENT TO RELEASE PERSONAL INFORMATION
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the person to whom the information described below relates, born on .
I authorize ______ to release the following information or records: ______, to ______.
This consent is subject to the following limits or conditions: .
I give this consent freely for the following purpose: . This consent remains in effect until I revoke it in writing.
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.
DECLARED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.
_______________________________ _______________________________
A Commissioner for taking Affidavits Signature of Declarant
Consent to Release Personal Information
A compact preview of this template
Your Information
Your full legal name
Your date of birth
Your full address
CONSENT TO RELEASE PERSONAL INFORMATION
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the person to whom the information described below relates, born on .
I authorize ______ to release the following information or records: ______, to ______.
This consent is subject to the following limits or conditions: .
I give this consent freely for the following purpose: . This consent remains in effect until I revoke it in writing.
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.
DECLARED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.
_______________________________ _______________________________
A Commissioner for taking Affidavits Signature of Declarant
How it works
Answer the questions, choose the download you need, then continue with signing or booking.
Overview
It is a sworn authorization for a holder of your records to share them with a named person or body, with any limits you set.
Holders often require clear, signed authorization before releasing records.
It authorizes sharing your records.
Once you have filled in your consent to release personal information and downloaded the PDF, a notary public can witness and notarize your signature so a third party can rely on it.
Minute Notary notarizes your consent to release personal information online by secure video, under Ontario's remote commissioning rules (O. Reg. 431/20), or in person in Ottawa. Bring valid government-issued photo identification.
Frequently asked
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Fill it outFill it in online, then download a ready-to-sign PDF or an editable Word copy. Use the generated PDF to continue to booking.