Government of Ontario

Tribunals Ontario
Fire Safety Commission

15 Grosvenor St, Ground Fl
Toronto ON  M7A 2G6
Telephone: 416-326-1356 / 1-888-777-3616
Teletypewriter (TTY): 1-800-855-0511
Fax: 416-314-4270 / 1-800-720-5292
Website: tribunalsontario.ca/fsc
Email: FSCregistrar@ontario.ca

Declaration of Representative

Important Information

• If you have a representative for a matter before the Commission, have them fill in this form clearly and completely and provide it to the Commission and all other parties immediately.
• You must notify the Commission and all parties in writing if the representative you name stops representing you and you find a new representative, or you decide to represent yourself.
• Only persons licenced by the Law Society of Upper Canada (LSUC) or who fall within the exceptions or exemptions approved by the LSUC may represent a party before the Tribunal.
• For the current list of exemptions for unlicensed representatives, visit the LSUC website at www.lsuc.on.ca or contact them at 416-947-3300 or 1-800-668-7380.

1. Representative Information

Last Name
First Name
Middle Initial

Company Name

Telephone Number
Fax Number
Email Address

2. Declaration of Representative

I am representing (Name of Party)

3. Acknowledgement

I acknowledge that I am licensed by the Law Society of Upper Canada (LSUC) to provide legal services.
My LSUC No. is

I acknowledge I am an unlicensed representative covered by an exemption allowed by the LSUC.

Name of Representative

Signature of Representative


Date (yyyy/mm/dd)

The Fire Safety Commission collects the personal information requested on this form under sections 26, 33, and 36 of the Fire Protection and Prevention Act, 1997. This information is being collected for the purpose of conducting a proceeding before the FSC. Any questions about this collection may be directed to the Fire Safety Commission at 416-326-1356 or toll-free at 1-888-777-3616 or teletypewriter (TTY) at 1-800-855-0511.