Human Rights Tribunal of Ontario

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Statement of Delivery (Form 23)

(Disponible en français)
When filing a document with the Tribunal, you must deliver the document to all other parties or, if they have a representative, to their representative. Complete this form to confirm that you have delivered your document and to tell the Tribunal when and how you did so. The Tribunal will not accept a document for filing unless you have confirmed delivery to the other participants in the Tribunal process.

Application Information

Tribunal File Number:


Name of Applicant:


Name of each Respondent:


Document Delivery Information

Party filing this form: Applicant Respondent Intervenor Other:       

Name of person completing this form:       
On:      I sent:       

(date) (name of Form(s) or document(s) that you are declaring you sent)


(your Form(s) or document(s) must be delivered to all other parties to the application or their representative)

The Form(s) or document(s) were delivered by:       

(indicate method of delivery)


By signing my name, I declare that, to the best of my knowledge, the information that is found in this form is complete and accurate.




Signature Date (dd/mm/yyyy)

 Please check this box if you are filing your Statement electronically. This represents your signature.

You must fill in the date, above.

Freedom of Information and Privacy

The Tribunal may release information about an Application in response to a request made under the Freedom of Information and Protection of Privacy Act. Information may also become public at a hearing, in a written decision, or in accordance with Tribunal policies. At the request of the Commission, the Tribunal must provide the Commission with copies of applications and responses filed with the Tribunal and may disclose other documents in its custody or control.

01/07/2010 Form 23 – Page of

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