AFFIDAVIT
___________________________________________

This Affidavit (the “Agreement”) is made and effective [DATE],

BETWEEN:                    [YOUR COMPANY NAME] (the "Company"), a corporation organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at:

[YOUR COMPLETE ADDRESS]

AND:                              [AFFIANT NAME] (the "Affiant"), a corporation organized and existing  
under the laws of the [State/Province] of [STATE/PROVINCE], with its head  
office located at:


[COMPLETE ADDRESS]

In consideration of the terms and covenants of this agreement, and other valuable consideration, the parties agree as follows:

RECITALS

BEFORE ME, the undersigned authority, [name and capacity of officer before whom affidavit is sworn], on this [day of month] day of [month], [YEAR], personally appeared Affiant, known to me to be a credible person and of lawful age, who being by me first duly sworn, on [his or her] oath, deposes and says:

[set forth statement of facts]

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written.

COMPANY                                                                   AFFIANT

_______________________________                     ___________________________________

Authorized Signature                                                     Authorized Signature

_______________________________                    ___________________________________ 

Print Name and Title                                                     Print Name and Title

 
ACKNOWLEDGMENT
_______________________________________________

State of [state]

County of [county]

On [date] before me, [name of notary], notary, personally appeared [name of person(s) involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

Signature                                                                                                                                                                                    Notary

(Seal)