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The following form is to be used where original documents or records are attached.

I, ____________________________, knowing that I may be prosecuted under the laws of ___________________________ for intentionally making a false statement or affidavit, MAKE OATH AND SAY AS FOLLOWS:

1. I am employed by _______________________________ (hereinafter _____________________). I am employed as ______________________________, and by virtue of that employment have knowledge of the matters hereinafter set out.

2. Attached to this my Affidavit are original documents or records maintained by the ______________________ in the usual and ordinary course of business.

3. The attached records or documents were created in the ordinary course of the business of the _________________ by persons who at the time of the making of the entry or record or document had knowledge of the circumstances or events set out therein.

4. The attached records or documents were made at or near the time of the circumstances or events set out therein by persons who were under a duty to accurately record the circumstances or events.

5. I believe the attached records or documents to be accurate.

Sworn before me this day  __________ of ____________, 200

at the City of_______________________________________

in _______________________________________________



(Insert name and qualifications of individual with authority to take sworn declarations or statements, and position.)


n.b.: In addition to the usual consular officials, a judicial official in a foreign jurisdiction is also authorized pursuant to the Canada Evidence Act to receive this affidavit by signing on the line immediately above, provided the official is authorized to administer, take or receive an oath, affidvavit, declaration, etc. in the same foreign jurisdiction.