Statutory Declaration of Financial Hardship

STATUTORY DECLARATION OF FINANCIAL HARDSHIP

I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:

1. I am currently experiencing financial hardship, described as follows: ______.

2. My approximate monthly income is ______, and I support ______ dependent(s).

3. My major monthly expenses or debts include: ______.

4. Because of these circumstances, I am unable to meet the cost in question, and I respectfully request: ______.

5. The information above is a true and accurate statement of my financial situation.

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