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Affidavits
Declare your immunization history under oath when an employer, school, or other organization in Ontario requires formal proof of vaccination beyond standard records.
Also known as
Vaccination Status Affidavit
I, ______, of the city of ______, in the province/state of ______, DO SOLEMNLY DECLARE AND STATE:
I was born on ______ in ______.
I hereby swear or affirm that I received the following vaccines:
Vaccine Name: ______
Date Vaccine Received: ______
I swear this Affidavit in support of my submission to ______, and for no other unlawful or improper purpose.
Supplementary details
Current citizenship: ______
How it works
Answer the questions on the left. Your document builds itself on the right as you type.
Get a clean, ready-to-sign PDF in seconds. No account, no watermark.
Book an appointment, bring your document, and we witness your signature and apply the seal.
A vaccination status attestation affidavit is a sworn statement in which you declare under oath that you have received specific vaccinations. It is used when an employer, educational institution, or other organisation requires formal proof of your immunization history and you cannot produce the original vaccination records, or when the requesting party requires a sworn document rather than a printout.
The affidavit does not replace a medical record. It is your personal sworn attestation that you received the vaccinations you list in the document. Whether the requesting party accepts a sworn attestation in place of official records is entirely their decision.
There are several common situations where a sworn vaccination attestation becomes useful. In each case, the person needs to prove their immunization history but lacks the standard documentation.
The form gathers your personal details and the vaccination history you are attesting to. Have this information ready before your appointment.
The notary's role is limited and specific: to verify your identity, administer the oath or affirmation, watch you sign, and complete the jurat. The notary does not verify that you actually received the vaccinations you describe. They do not provide medical advice and cannot guarantee the affidavit will be accepted by any particular employer or authority.
You are personally responsible for the accuracy of what you swear to. If you are uncertain about dates or vaccine names, gather what records you can before your appointment.
The process takes only a few minutes once your information is ready.
A sworn attestation is not the same as an official vaccination certificate from Ontario Public Health or any health authority. It is your personal declaration about your vaccination history. Some organisations accept it as supplementary proof when official records are unavailable; others may not. Check with the requesting party before swearing the affidavit so you are certain it will serve your needs.
Swearing a false affidavit is perjury under section 131 of the Criminal Code of Canada, an indictable offence carrying up to 14 years' imprisonment. Any decision made in reliance on the false affidavit can also be reversed.
Frequently asked
Fill it in online, download a ready-to-sign PDF, then bring it in and we will notarize it, in person across Ottawa or online.