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DECLARATION AND UNDERTAKING

IN THE MATTER OF an appeal by (insert name of appellants) from a decision of (insert name of respondent).

I [insert name], a(n) [employee, officer, director etc.] of/a [witness, representative, consultant, etc.] for the appellant/respondent, DECLARE THAT:

I am ordinarily resident in Canada;

I am/am not an employee, officer, director or shareholder of the party for whom I appear or any other person known by me to be a participant at this hearing;

I have read/been informed of the Rules of Procedure of the [insert name of Tribunal] and the orders of the Tribunal that relate to this hearing;

I understand that the order of the Tribunal may be filed with the Ontario Court (General Division); and

I understand that any breach of the Tribunal's orders could be the subject of contempt proceedings in the Superior Court of Justice.

AND UNDERTAKE THAT:

I will maintain the confidentiality of any information or evidence presented during that portion of the hearing held in the absence of the public and I will not disclose any such information or evidence to any person who is not entitled to know it;

I will not reproduce in any manner, without the prior written approval of the Tribunal, any information or evidence presented during that portion of the hearing held in the absence of the public, or any notes, transcripts or written submissions dealing with information received, evidence taken, and submissions made during or in respect of that portion of the hearing,

I will ensure that no other individual shall copy or disclose any information or evidence presented during that portion of the hearing held in the absence of the public, or any notes, transcripts or written submissions dealing with information received, evidence taken, and submissions made during or in respect of that portion of the hearing; and

I will personally deliver to the secretary of the Tribunal [at the end of the hearing/after the appeal period has passed] any notes, transcripts or written submissions dealing with the information received, evidence taken and submissions made during or in respect of that portion of the hearing held in the absence of the public.

Signature____________________________________ Date: ____________

Printed Name ___________________________________