Statutory Declaration of Name Discrepancy

STATUTORY DECLARATION OF NAME DISCREPANCY

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

1. My name as it appears on my ______ is ______.

2. My name as it appears on my ______ is ______.

3. Both names refer to one and the same person, namely myself. I have never used the differing versions of my name for any improper purpose, and I am not attempting to conceal my identity.

4. The discrepancy arose because: ______.

5. My date of birth is ______, and my place of birth is ______.

6. Any additional names or spellings I have used are: .

7. 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 Deponent