Maximum number of dependents reached.
Maximum number of people reached.
I declare and affirm that the information provided by me on this application form is complete and correct and is given in order to substantiate my entitlement to social assistance.
I agree and advise the Administrating Authority of any change in my financial status, income, marital status, family size, or other circumstances that may affect my eligibility for benefits.
I further consent to the Administrating Authority disclosing any information in this application to any such source or any such reporting agency, in order to verify or confirm the information, and further consent to any such source disclosing information to the administrating authority in order that it can verify or confirm the information in this application.
*Social assistance benefits obtained under false pretence or misrepresentation may lead to prosecution under the criminal code of Canada.