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Ontario Land Tribunal
655 Bay Street, Suite 1500, Toronto, ON M5G 1E5
Tel: 416-212-6349 | 1-866-448-2248
Web Site:

Representative of a Party – Commencement of Authorization Form

Date of Notification to the Tribunal (yyyy/mm/dd):

Case Information
OLT Case No.: Hearing Date (if known): Municipality:

I , herby authorize to act as my representative in all matters for the purposes of the above noted proceeding before the Ontario Land Tribunal.

Representative’s Contact Information
Last Name : First Name :
Name of firm or organization (if applicable):
Email Address:
Daytime Telephone Number: Alternative Telephone Number:
Postal adress
Unit Number : Street Number : Street Name : P.O. Box
City/Town : Province: Country : Postal Code:

Representative’s Declaration
I declare that the information provided above is truthful, complete and correct. I acknowledge that I am either licensed by the Law Society of Ontario (LSO) to provide legal services or that I am an unlicensed representative covered by an exemption allowed by the LSO. I have been authorized by the appointing party to represent him/her/it throughout the proceeding before the Ontario Land Tribunal and have the authority to bind the party with respect to withdrawal and all other issues.
Signature of Representative Date (yyyy/mm/dd)