Use this Statutory Declaration, to deal with a Hit and Run incident where you believe, for example, that the other vehicle was not insured. Further, complete this form if you believe that due to the death or bodily injury, you (the Applicant) are not entitled to be protected by the following: BC Medical Insurance, BC Hospital Insurance or Workers’ Compensation Benefits; other medical insurance, hospital insurance, or BC Workers’s compensation under a public or private.
By signing the CL42 Declaration in Burnaby before a Notary, you agree that due to the death (bodily injury, loss of, or damage to property), you are not entitled to indemnity from any public or private insurance company or plan. By signing the document, you are making a solemn declaration, which has the force and effect as making an oath in court, the document is true.
The document must be sworn and signed before a Notary or Commissioner for Taking Affidavits in Burnaby. You may book an appointment online, or we may come to you to have the document notarized.
Schedule Appointment Notary Public’s Office in Burnaby