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filed November 26, 2013 under Municipal Elections Act, 1996, S.O. 1996, c. 32, Sched.

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made under the


Made: November 25, 2013
Filed: November 26, 2013
Published on e-Laws: November 27, 2013
Printed in The Ontario Gazette: December 14, 2013


Proof of identity and residence

1. The following is prescribed as the proof of identity and residence that a person may present for the purposes of subparagraph 1 ii of subsection 52 (1) of the Act:

1. An original, or a certified or notarial copy, of a document that is listed in Schedule 1 and shows the person’s name and qualifying address.

Form for application and statutory declaration

2. The following is prescribed as the form that a person may complete for the purposes of subparagraph 1 ii of subsection 52 (1) of the Act:

1. Form 9, entitled “Declaration of Identity” (application and statutory declaration under subparagraph 1 ii of subsection 52 (1) of the Act), dated November, 2013 and available on the website of the Government of Ontario Central Forms Repository under the listing for the Ministry of Municipal Affairs and Housing.


1. An Ontario driver’s licence.

2. An Ontario Health Card (photo card).

3. An Ontario Photo Card.

4. An Ontario motor vehicle permit (vehicle portion).

5. A cancelled personalized cheque.

6. A mortgage statement, lease or rental agreement relating to property in Ontario.

7. An insurance policy or insurance statement.

8. A loan agreement or other financial agreement with a financial institution.

9. A document issued or certified by a court in Ontario.

10. Any other document from the government of Canada, Ontario or a municipality in Ontario or from an agency of such a government.

11. Any document from a Band Council in Ontario established under the Indian Act (Canada).

12. An income tax assessment notice.

13. A Child Tax Benefit Statement.

14. A Statement of Employment Insurance Benefits Paid T4E.

15. A Statement of Old Age Security T4A (OAS).

16. A Statement of Canada Pension Plan Benefits T4A (P).

17. A Canada Pension Plan Statement of Contributions.

18. A Statement of Direct Deposit for Ontario Works.

19. A Statement of Direct Deposit for Ontario Disability Support Program.

20. A Workplace Safety and Insurance Board Statement of Benefits T5007.

21. A property tax assessment.

22. A credit card statement, bank account statement, or RRSP, RRIF, RHOSP or T5 statement.

23. A CNIB Card or a card from another registered charitable organization that provides services to persons with disabilities.

24. A hospital card or record.

25. A document showing campus residence, issued by the office or officials responsible for student residence at a post-secondary institution.

26. A document showing residence at a long-term care home under the Long-Term Care Homes Act, 2007, issued by the Administrator for the home.

27. A utility bill for hydro, water, gas, telephone or cable TV or a bill from a public utilities commission.

28. A cheque stub, T4 statement or pay receipt issued by an employer.

29. A transcript or report card from a post-secondary school.


3. Ontario Regulation 500/09 is revoked.


4. This Regulation comes into force on the day it is filed.

Made by:
Pris par :

La ministre des Affaires municipales et du logement,

Linda Jeffrey

Minister of Municipal Affairs and Housing

Date made: November 25, 2013.
Pris le : 25 novembre 2013.