Representative Information
I hereby authorize the named company and/or individual(s) to represent
me
Last Name:
First Name:
Company Name:
Email Address(es):
LSO Number(if applicable):
Daytime Telephone Number:
ext.
Alternative Telephone Number:
Mailing Address:
Unit Number:
Street Number:
Street Name:
P.O. Box:
City/Town:
Province:
Country:
Postal Code:
Note: If your representative is not licensed under the Law Society Act, please
confirm that they have your written authorization, as required by the OLT Rules of Practice and
Procedure, to act on your behalf and that they are also exempt under the Law Society’s by-laws
to provide legal services. Please confirm this by checking the box below.
I certify that I understand that my representative is not licensed
under the Law Society Act and I have provided my written authorization to my representative to
act on my behalf with respect to this matter. I understand that my representative may be asked
to produce this authorization at any time along with confirmation of their exemption under the
Law Society’s by-laws to provide legal services.