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Statutory declarations
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.
Word files are editable. Review any changes carefully before signing or uploading.
Also known as
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, 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
Statutory Declaration of Caregiver for a Dependent Adult
A compact preview of this template
Caregiver 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, 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, choose the download you need, then continue with signing or booking.
Overview
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.
It supports caregiver credits and benefits.
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.
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.
Frequently asked
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