Statutory declarations
Statutory Declaration of Caregiver for a Dependent Adult
A sworn declaration that you provide care to a dependent adult — useful to support care, tax credit, or benefit applications. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
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Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Caregiver Affidavit
- Declaration of Care for a Dependent Adult
- Attendant Care Declaration
+1 more names
- Sworn Statement of Caregiving
STATUTORY DECLARATION OF CAREGIVER FOR A DEPENDENT ADULT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I provide care and support to ______, who is my ______.
I have provided this care since ______. The care and support I provide includes: ______.
Our living arrangement is: ______.
I make this declaration to support a care, credit, or benefit matter. Specific purpose (if any):
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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- General template, not legal advice
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Statutory Declaration of Caregiver for a Dependent Adult
A compact preview of this template
01Caregiver Information
Your full legal name
Full name of the dependent adult
Your full address
STATUTORY DECLARATION OF CAREGIVER FOR A DEPENDENT ADULT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I provide care and support to ______, who is my ______.
I have provided this care since ______. The care and support I provide includes: ______.
Our living arrangement is: ______.
I make this declaration to support a care, credit, or benefit matter. Specific purpose (if any):
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 a caregiver declaration?
It is a sworn statement — also called a caregiver affidavit or attendant care declaration — describing the care you provide to a dependent adult and the caregiving relationship.
Programs and credits sometimes require sworn confirmation of the relationship and care.
- 02
When you might need one
It supports caregiver credits and benefits.
- Applying for a caregiver credit or benefit.
- A program asks you to confirm the care you provide to a dependent adult.
- You must state since when, and how, you provide care.
- 03
What to include
Identify the dependent adult and your relationship, describe the care and support you provide, state since when, and describe your living arrangement. Keep supporting records available if the program asks for them.
- 04
How to notarize a caregiver declaration for a dependent adult in Ontario
After you fill in your caregiver declaration for a dependent adult 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 caregiver declaration for a dependent adult 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 Caregiver for a Dependent Adult
- What is a caregiver declaration for a dependent adult used for?
- To confirm under oath the care and support you provide to a dependent adult, supporting a caregiver credit, benefit, or care matter.
- Is this for caring for a child?
- No. This is for a dependent adult. A separate document is used for authorizing care of a minor child.
- Does it decide my eligibility for a credit?
- No. It supports your application; the program or tax authority decides eligibility under its own rules.
- 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.
Keep exploring
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Fill it out - 03Statutory Declaration of Receipt of Funds
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Fill it out - 04Statutory Declaration of Common-Law Partnership
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Fill it out
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