I, (name in full), of ,

MAKE OATH AND SAY:

• 1. I am the (title or office) of , the applicant, and, as such, I am submitting the application for deposit insurance.

• 2. The representations made in the application and in all attachments and any supplementary information or documents provided by the applicant to the Canada Deposit Insurance Corporation in connection with the application are true and correct, in all material respects, and contain no misrepresentations.

SWORN before me at the City of	)
	)
__________ in the	)
	)
of __________	)
	)
this day of __________, 20.	)	__________
	)	(Signature)
	)
	)
__________	)
Commissioner of Oaths	)

I, (name in full), of ,

MAKE OATH AND SAY:

• 1. I am the (title or office) of , the entity that controls , the applicant.

• 2. The representations made and the information and documents provided by the entity that controls the applicant in support of the application made by the applicant for deposit insurance are true and correct, in all material respects, and contain no misrepresentations.

SWORN before me at the City of	)
	)
__________ in the	)
	)
of __________	)
	)
this day of __________, 20.	)	__________
	)	(Signature)
	)
	)
__________	)
Commissioner of Oaths	)