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Statutory Declaration of Revocation of Authorization
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STATUTORY DECLARATION OF REVOCATION OF AUTHORIZATION
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I previously gave the following authorization or consent: ______, to ______. Date it was originally given, on or about (if known):
I now revoke that authorization in full, effective ______.
From the effective date, ______ has no further authority to act under it, and it is of no further force or effect.
I have taken reasonable steps to give notice of this revocation. Purpose of this declaration (if specified):
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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