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Statutory Declaration of Non-Receipt
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.
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Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Affidavit of Non-Receipt
- Declaration of Non-Delivery
- Non-Receipt of Payment Affidavit
+1 more names
- Sworn Statement of Non-Receipt
STATUTORY DECLARATION OF NON-RECEIPT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I was expecting to receive the following ______: ______, from ______.
Date it was expected, on or about (if known):
Amount or value (if applicable):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. Specific purpose (if any):
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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Statutory Declaration of Non-Receipt
A compact preview of this template
01Your 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 ______.
Date it was expected, on or about (if known):
Amount or value (if applicable):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. Specific purpose (if any):
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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Overview
About this document
- 01
What is a non-receipt declaration?
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.
- 02
When you might need one
It supports refund and claim requests.
- A package or item you paid for never arrived.
- A payment or cheque you were owed was not received.
- A company or insurer asks for sworn confirmation of non-receipt.
- 03
What to include
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.
- 04
How to notarize a statutory declaration of non-receipt in Ontario
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.
Good to know
Before you fill it in.
Short notes from our notary on this template. Worth a minute before you start.
- 01
Reviewed for use in Ontario by a notary public and commissioner for taking affidavits.
- 02
Fill it in online for free and download a ready-to-sign PDF — no account required.
- 03
Sign in front of the notary, who administers your oath or affirmation and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Statutory Declaration of Non-Receipt
- When do I need a non-receipt declaration?
- When a package, payment, or item you were expecting never arrived and a company, bank, or insurer asks for sworn confirmation to support a refund, reissue, or claim.
- Will it guarantee a refund or reissue?
- No. It supports your request; the company, bank, or insurer decides under its own process and may ask for more information.
- Can I notarize it online in Ontario?
- Yes. You can swear it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- What if the item arrives later?
- Notify the other party promptly. Your declaration states the item had not reached you as of the date you swore it.
Keep exploring
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Fill it out - 03Statutory Declaration of Occupancy of a Property
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Fill it out - 04Statutory Declaration of Ownership of Property
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Fill it out
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