Sworn Statement - Proof Of Residence Form
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1
2SWORN STATEMENT – PROOF OF RESIDENCE
SEE INSTRUCTIONS ON REVERSE SIDE
To be completed by the person stating, under oath, the place of residence of the card applicant
Section
I, the undersigned,
, domiciled at
First and last names of the landlord, the landlord's representative or the tenant whose name appears on the lease
,
Number, street, apartment, municipality and postal code
and whose phone number is
, solemnly declare that
Area code
First and last names of the card applicant
is currently domiciled at the above-mentioned address or at (if the applicant's address is different from yours)
Number, street, apartment, municipality and postal code
and that I am the landlord, the landlord's representative or the tenant whose name appears on the lease.
To be completed before a commissioner for oaths
Section
I solemnly declare that all the information in this statement is accurate and complete.
First and last names in block letters
X
Signature of the person making the sworn statement
Seal
Sworn before me at
.
Location
First and last names of the commissioner
Commissioner number or title
Signature of the commissioner for oaths
Date
This statement is valid for 45 days from the date it is signed by the commissioner for oaths.
4249
365
15/07
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Parent category: Legal