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A sworn statement listing the addresses where you have lived over a period — often required for security clearances, immigration, or background checks.
Also known as
STATUTORY DECLARATION OF ADDRESS HISTORY
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
For the period covering ______, I have lived at the following addresses, with the dates shown: ______.
To the best of my knowledge and recollection, the above is a complete and accurate record of the addresses where I have lived during that period, with no gaps.
I make this declaration 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.
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 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.
It is a sworn record of where you have lived over a defined period, with the dates for each address.
Security clearances, immigration applications, and background checks often require a complete address history with no unexplained gaps.
You may need it when:
Have ready:
Fill in the form and download a clean, ready-to-sign PDF. Do not sign it yet — it must be signed in front of a notary public or commissioner for taking affidavits.
Book an appointment with Minute Notary. We administer your oath or affirmation, witness your signature, and apply the seal — online where eligible, or in person in Ottawa.
Frequently asked
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