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Statutory Declaration of Address History
A sworn declaration listing the addresses where you have lived over a period — often required for security clearances, immigration, or background checks. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
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Also known as
- Residential History Declaration
- Address History Affidavit
- Declaration of Past Addresses
+1 more names
- Sworn Address History
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.
Purpose of this declaration (if specified):
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.
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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Statutory Declaration of Address History
A compact preview of this template
01Your Information
Your full legal name
Period this declaration covers (e.g. the past ten years)
Your full address
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.
Purpose of this declaration (if specified):
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.
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 an address history declaration?
It is a sworn statement — also called a residential history declaration or declaration of past addresses — recording where you have lived over a defined period, with the dates for each address.
It is used where a complete, gap-free address history must be confirmed under oath.
- 02
When you might need one
It supports clearances and checks.
- A security clearance or background check requires your address history.
- An immigration application asks where you have lived over several years.
- An institution needs a sworn, gap-free record of your residences.
- 03
What to include
List each address in order with the dates you lived there, and account for the whole period with no gaps. Note any time abroad or in temporary housing, and indicate where a date is approximate.
- 04
How to notarize a statutory declaration of address history in Ontario
After you fill in your statutory declaration of address history 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 statutory declaration of address history 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 so we can verify your identity before applying the notary seal.
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 affirmation and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Statutory Declaration of Address History
- When do I need an address history declaration?
- For a security clearance, background check, or immigration application that requires a sworn, gap-free record of where you have lived.
- Why must it have no gaps?
- Clearances and checks rely on a continuous record. List addresses in order and account for the whole period, including time abroad or in temporary housing.
- Can I notarize it online in Ontario?
- Yes. You can swear it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- What if I cannot recall exact dates?
- Give your best recollection and indicate where a date is approximate, so the record stays accurate and honest.
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Fill it out
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Fill it in online, then download a ready-to-sign PDF or an editable Word copy. Use the generated PDF to continue to booking. Not sure what the appointment involves? Read about the Statutory Declarations service first.