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Statutory Declaration - to be completed by consultants

Canada, Province or Territory of ________________________

IN THE MATTER OF an agreement bearing no.________________________ and dated the ________________________ day of ________________________ , 20 ________________________ between HER MAJESTY THE QUEEN in right of Canada, and ________________________ (Full Name of Consultant) hereinafter referred to as the Consultant, for ________________________ (Description and location of project) and IN THE MATTER OF (1) a service completed or (2) the final payment for the services as indicated by a CHECKMARK in APPLICABLE BOX below.


I, ________________________ (Name of Declarant) , of ________________________(Declarant's Address) do solemnly declare that I am ________________________ (Capacity of Declarant) and as such have personal knowledge of the said agreement and the facts and matters stated herein, and

(1) ( ) that, up to the date of completion of the service described in the agreeement as:________________________ (Print or type the service attested as described) the Consultant has complied with and discharged all its lawful obligations arising out of the execution of this service.


(2) ( ) that, up to the date of final completion of the services, the Consultant has complied with and discharged all its lawful obligations in respect of the services contracted for and discharged and satisfied all lawful claim against it that arose out of the performance of the services, except for the amounts owing which total $ ________________________ .
A detailed explanatory statement of the amounts owing, including any amounts in dispute, must be attached as part of this Statutory Declaration.

And I make this SOLEMN DECLARATION conscientiously believing it to be true and knowing it is of the same force and effect as if made under oath, and by virtue of the CANADA EVIDENCE ACT.


________________________ (Signature of Declarant)

Witnessing Authority:
Please clearly state authority for receiving solemn declarations

________________________ (Notary Public, Commissioner, or other authorized officer)

DECLARED before me at ________________________ this ________________________ day of ________________________ , 20 ________________________

________________________ (Signature of person before whom the Declaration is made)

________________________ (Name of person before whom the Declaration is made) Notaries affix Notarial Seal


If this Declaration is not complete in every detail, it will be returned for completion and payment will be delayed. Sections 131 and 361 of the Criminal Code of Canada which deal with offences relating to affidavits are hereby brought to the attention to the Declarant.