Affidavits
Vaccination Status Affidavit
A sworn affidavit attesting to your vaccination status. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario. The body requesting it decides whether to accept it; this is not medical advice.
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Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Vaccination Attestation Affidavit
- Sworn Proof of Vaccination
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 improper purpose.
I am a ______ of Canada.
AND 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 and by virtue of the Canada Evidence Act.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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- Scope
- General template, not legal advice
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Vaccination Status Affidavit
A compact preview of this template
01Your Details
Full legal name
City of residence
Vaccination particulars
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 improper purpose.
I am a ______ of Canada.
AND 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 and by virtue of the Canada Evidence Act.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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Overview
About this document
- 01
What is a proof of vaccination affidavit?
It is a sworn attestation of your vaccination status, sworn before a notary public or commissioner for taking affidavits.
The notary witnesses the sworn statement; an official vaccination record is the primary proof where one is available.
- 02
Good to know
Where an official vaccination record exists, that is the usual proof. This affidavit attests to your status under oath; the organization requesting it decides whether it accepts it. It is not medical advice.
- 03
How to notarize a proof of vaccination affidavit in Ontario
After you fill in your proof of vaccination affidavit and download the PDF, do not sign it in advance. A sworn document must be signed in front of a notary public or commissioner for taking affidavits, who administers your oath or solemn affirmation first.
Minute Notary commissions your proof of vaccination affidavit 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.
Good to know
Before you fill it in.
Short notes from our notary on this template. Worth a minute before you start.
- 01
Reviewed for use in Ontario by a notary public and commissioner for taking affidavits.
- 02
Fill it in online for free and download a ready-to-sign PDF — no account required.
- 03
Sign in front of the notary, who administers your oath or witnesses your signature and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Vaccination Status Affidavit
- When would I use this?
- To attest to your vaccination status under oath where an official record is unavailable or a body asks for a sworn statement; the body decides whether it accepts it.
- Does it replace an official vaccination record?
- No. Where an official record exists, that is the usual proof. This attests to your status under oath.
- Can I notarize it online in Ontario?
- Yes. You can complete it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- Is this medical advice?
- No. The notary witnesses the sworn statement only; it is not medical advice.
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Fill it out - 04General Affidavit (Ontario)
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Fill it out
Ready to sign?
Ready to create your Vaccination Status Affidavit?
Fill it in online, then download a ready-to-sign PDF or an editable Word copy. This document must be signed in person. Not sure what the appointment involves? Read about the Statutory Declarations service first.