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A sworn declaration that you did not receive goods, a payment, or an item you were expecting — useful to support a dispute, refund, reissue, or insurance claim. 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 NON-RECEIPT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I was expecting to receive the following ______: ______, from ______.
It was expected on or about , with an amount or value of .
I did not receive it. The circumstances, and what I have done about it, are as follows: ______.
To the best of my knowledge, the item has not come into my possession or control.
I make this declaration to support a refund, reissue, or claim, 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 Non-Receipt
A compact preview of this template
Your Information
Your full legal name
What you did not receive
Your full address
STATUTORY DECLARATION OF NON-RECEIPT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I was expecting to receive the following ______: ______, from ______.
It was expected on or about , with an amount or value of .
I did not receive it. The circumstances, and what I have done about it, are as follows: ______.
To the best of my knowledge, the item has not come into my possession or control.
I make this declaration to support a refund, reissue, or claim, 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
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Overview
It is a sworn statement — also called an affidavit of non-receipt or declaration of non-delivery — confirming that an expected item or payment did not arrive and has not come into your possession.
It is used to support a refund, reissue, or claim where you must confirm non-receipt under oath.
It supports refund and claim requests.
Describe what you were expecting and from whom, the date and value, and confirm you did not receive it and have taken reasonable steps about it. Notify the other party promptly if the item later arrives.
After you fill in your statutory declaration of non-receipt 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 statutory declaration of non-receipt 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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