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      • Disclosure Veto, No-Contact Declaration, and Cancellation Forms

Disclosure Veto, No-Contact Declaration, and Cancellation Forms

• Check Before You Send
• Instructions
• Form and Envelope Downloads
• Mailing Address
• False Statements

Check Before You Send

• Confirm that you are permitted to file the Disclosure Veto, No-Contact Declaration, or Cancellation form.
• Complete all relevant sections of the form. If information required on the form is unknown to you, please provide a written explanation. If any portion of the relevant information is left blank, the application will be returned.
• Attach a photocopy of your legal birth certificate.

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Instructions

Place the written statement in the written statement envelope (pink preferred). Place the sealed confidential statement envelope in another envelope (grey preferred) along with the Disclosure Veto or No Contact Declaration, and Written Statement, a photocopy of your birth certificate (a baptismal certificate is not acceptable).

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Form and Envelope Downloads

Note: all links below are PDFs and will open in a new window.

• Disclosure Veto and Written Statement (268 KB)
• No-Contact Declaration and Written Statement (273 KB)
• Cancellation of Disclosure Veto or No-Contact Declaration (41 KB)
• Statutory Declaration (258 KB)
• Mailing Envelope (Optional: These downloads are provided for your convenience.) Grey envelopes are preferred.
• #10 Envelope 4.122 x 9.5" (105 KB)
• #9 Envelope 3.874 x 8.87" (104 KB)
• Written Statement Envelope (See an Example) Pink envelopes are preferred. Please use a second envelope to conceal the confidential written statement. You must tick one item indicating who has filed the statement and the intended recipient.

Written Statement Envelope

The Written Statement envelopes (available for download on this page) are recommended if you have Adobe Acrobat, a printer and #9 or #10 envelopes. Alternately, you may obtain a copy from any of the Government Service Centres or Vital Statistics Division locations. If you must create your own written statement envelope, please follow the following directions.

1. Seal your written statement in an envelope (pink envelopes preferred).
2. Clearly label it (See an Example): The "Office Use Only" and "Instructions" portions are not required.

  WRITTEN STATEMENT

  This statement is being filed by the:
  (Please tick one)

    [ ] Adopted Person
    [ ] Birth Mother
    [ ] Birth Father

  for the:
  (Please tick one)

    [ ] Adopted Person
    [ ] Birth Mother
    [ ] Birth Father

• Tick one selection indicating who you are.
• Tick one selection indicating who the recipient is.
• Put the sealed and labelled written statement envelope (pink preferred) in second envelope (grey preferred).
• In the second envelope: include the Disclosure Veto or No Contact Declaration, a photocopy of your legal birth certificate (a baptismal certificate is not acceptable), and the required fee.
• Address the envelope to the address provided below.

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Mailing Address

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False Statements

Under the Adoption Act, it is an offence to make a statement that the person knows to be false or misleading in an application, or in connection with an application, for a copy of a birth registration or other record from the Vital Statistics Division, or for filing a disclosure veto or a no-contact declaration.

A person who makes a false statement commits an offence and is liable on conviction to a maximum fine of up to $10,000 and/or a term of imprisonment.

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