• Integrity Declaration Form

  • SUPPLIER INFORMATION

  • Date of bid, offer submission date or closing date of Invitation to Offer
     - -

  • FOREIGN CRIMINAL OFFENCES

  • Date of charge/conviction
     - -

  • FOREIGN CRIMINAL CHARGES AND CONVICTIONS

  • If you are unable to certify that you have provided the required list of all foreign criminal charges and convictions received in the past three years, you must explain why. The explanation should be provided in a separate document under the heading Inability to Certify as to Foreign Criminal Charges and Convictions, to be included with this form. XXX may request additional information from you.An explanation regarding foreign criminal charges and convictions received in the past three years is provided in a separate document included with this form:

  • DOMESTIC CRIMINAL OFFENCES AND OTHER CIRCUMSTANCES

  • Rows
  • Rows
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  • Declaration

  • I,        ,            , of         declare that the information provided in this
    form is, to the best of my knowledge and belief, true, accurate and complete. XXX
    may request additional information relating to this declaration. I am aware that a false or
    misleading certification or declaration will result in my proposal or offer being deemed
    non-responsive. I am also aware that Canada may terminate a contract or real property
    agreement for default when a supplier has provided a false or misleading certification or
    declaration and, further to the Policy, the supplier will be ineligible for award of a
    contract or real property agreement for 10 years.

  • Format: (000) 000-0000.
  • Date
     - -
  • Clear
  • Should be Empty:
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