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A sworn statement of a general vaccination exemption position, notarized. 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 or legal advice.
Also known as
Vaccine Exemption Affidavit
I, ______ of ______, DO SOLEMNLY SWEAR AND DECLARE:
I was born on ______ in ______.
I am a citizen of ______.
I hereby request an exemption from receiving the ______ vaccine, or any related vaccines, boosters or other shots related to ______ and any of its variants.
The ______ vaccine ______.
The purpose of this Affidavit is to request a formal exemption from any mandatory or non-mandatory vaccination requirements, whether by law, health directive, provincial or state mandate, or resulting from an employer’s rules, policies or orders.
I swear this Affidavit in support of my request for a ______ vaccine exemption, and for no other unlawful or improper purpose.
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.
Overview
It is a sworn statement of a general vaccination exemption position, witnessed by a notary public or commissioner.
The notary administers the oath and witnesses the signature; it does not assess the exemption or provide medical or legal advice.
The organization, employer, or authority requesting it decides whether it accepts an exemption and on what terms. Confirm their requirements. This service is the notarization only and is not medical or legal advice.
After you fill in your general vaccination exemption statement 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 general vaccination exemption statement 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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