Affidavits
Statutory Declaration of Loss of Earnings
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STATUTORY DECLARATION OF LOSS OF EARNINGS
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
Employer or other source of my earnings (if specified):
During the period ______, I was unable to earn my usual income of ______.
As a result, I lost earnings in the amount of ______.
The loss of earnings occurred for the following reason: ______.
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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