Tenant’s Statement About Sexual or Domestic Violence and Abuse

Jurisdiction: Canada | Ontario

What is a Tenant’s Statement About Sexual or Domestic Violence and Abuse?

A Tenant’s Statement About Sexual or Domestic Violence and Abuse is a prescribed Ontario form. You use it to confirm that you, or a child living with you, have experienced sexual or domestic violence and that you fear for your safety in your current home. When you complete and deliver this statement with your 28-day notice to end your tenancy, you can legally end your tenancy early. You do not need to give detailed personal facts or evidence. The statement itself is enough.

This form exists to reduce the risk to you if you need to move quickly for safety reasons. It lets you end a fixed-term lease early, or a month-to-month tenancy, on short notice. You do not have to wait for your lease to run out. You do not have to provide a court order or a letter from a professional if you do not want to. The statement is designed to be simple, confidential, and quick.

Who typically uses this form? Tenants in Ontario rental housing who need to leave a unit because of violence or abuse. This includes tenants on a fixed-term lease, month-to-month tenants, and joint tenants. It also includes a tenant who is a parent of a child who has experienced sexual or domestic violence. You do not need to be the person who directly suffered the violence if you are the parent of the child who did.

Why would you need this form? You need it when you want to give the special 28-day notice to end your tenancy due to sexual or domestic violence or abuse, and you prefer not to submit other documents. The law allows you three options for supporting your notice. One option is this Tenant’s Statement. Many tenants choose it because it protects privacy and avoids delays.

Typical usage scenarios include:

• You are in a fixed-term lease with an abusive partner who is also a tenant. You need to leave quickly. You complete the Tenant’s Statement and give your 28-day notice. Your part of the tenancy ends on the date in your notice. You move without waiting for the lease to expire.
• You have a month-to-month tenancy. An ex-partner is stalking you and has threatened you. You complete the Tenant’s Statement and give your 28-day notice. You choose a termination date at least 28 days away and move.
• Your child discloses abuse, and the abuser knows your address. You complete the Tenant’s Statement as the parent. You give your 28-day notice and relocate for safety.
• You share with roommates. You need to exit because of abuse by someone associated with the home. You use the statement with your notice to end only your part of the tenancy.

The form is short and focused. It asks for your basic information and a confirmation of your fear for safety. You sign and date it. You give it only to your landlord with your 28-day notice. The landlord must keep it confidential.

When Would You Use a Tenant’s Statement About Sexual or Domestic Violence and Abuse?

You use this statement when you are ending your tenancy early because of sexual or domestic violence or abuse and you want to rely on your own statement rather than other documents. You attach it to your 28-day notice to end your tenancy for this reason. You do not file the statement with a court or a tribunal. You give it only to your landlord.

You would use it if you need to move quickly and cannot wait for a fixed-term lease to end. You would use it if providing a court order, bail terms, or a professional’s letter would compromise your safety or privacy. You would also use it if you simply prefer not to involve third parties. The law recognizes that you may not have formal documents and that getting them can take time. The statement is a self-contained option.

Tenants in many living situations use this form. That includes lone tenants, joint tenants, and tenants with children. It also includes students renting off-campus housing, tenants in basement apartments, and tenants in small or large buildings. If you are a named tenant on a tenancy agreement in Ontario and the residential tenancy laws apply to you, you can use the statement.

Here are practical examples:

• You rent a unit with your partner. Your partner becomes violent. You sign the statement and give your 28-day notice. Your portion of the tenancy ends on the termination date in your notice. Your partner’s tenancy can continue unless they also end it. You do not need your partner’s agreement to leave.
• You rent a room in a shared house. A neighbor or guest has sexually assaulted you. You sign the statement and give your 28-day notice. You move to a safer location. The landlord must accept your notice.
• You rent month-to-month. A restraining order exists, but you do not want to share it. You sign the statement instead. You give the notice. The landlord must treat the statement as sufficient.
• You are a parent. Your child has experienced abuse from someone who knows where you live. You sign the statement as the parent. You give the notice and relocate.

Business owners or landlords do not use this form. Landlords receive it. They must handle it confidentially and follow the termination date in the notice that comes with it. Property managers and supers may see that a notice was given, but they should not see the statement’s contents unless necessary to process the termination.

You can choose a termination date at least 28 days after the landlord receives your notice. It does not need to match your rent due date. You can move sooner than that if needed, but the tenancy ends on the date in your notice. Plan your move, key return, and utility shutoffs around that date.

If you have roommates and only you are leaving, the tenancy for the remaining tenants can continue. If you all want to leave, each tenant must have a valid basis to end their own tenancy or reach an agreement with the landlord. Your use of the statement does not automatically end the tenancy for others.

Legal Characteristics of the Tenant’s Statement About Sexual or Domestic Violence and Abuse

The Tenant’s Statement is a prescribed form under Ontario residential tenancy law. It is legally recognized as one of the permitted ways to support your special 28-day notice to end your tenancy due to sexual or domestic violence or abuse. When you complete it properly and serve it with your notice, it has legal effect. Your notice becomes valid and enforceable. Your part of the tenancy ends on the termination date in the notice.

It is legally binding because the statute and regulations authorize it. The law sets out the conditions, the content, and the required confidentiality. If you meet the conditions and serve the documents correctly, the landlord must accept them. The landlord cannot demand more details or proof. The landlord cannot refuse your notice because they disagree with your reasons. The landlord cannot delay termination beyond the date you selected, as long as you gave at least 28 days.

Enforceability rests on a few pillars:

• Proper completion. You must fill in the required information accurately. You must sign and date the statement.
• Proper service. You must give your landlord both your 28-day notice and your statement. You should keep proof of when and how you served them.
• Timing. The termination date in your notice must be at least 28 days after the landlord receives it.

Confidentiality is a core legal feature. The landlord must keep your statement and your notice confidential. They can use the information only to process the termination and manage the tenancy. They must store the statement in a secure way and limit access. They cannot show it to other tenants or disclose it to the person you fear. They must not use it for other purposes. If they breach confidentiality, legal penalties can apply.

There are also penalties for misuse by anyone. It is an offence to knowingly give false or misleading information in connection with a tenancy. Do not exaggerate or invent details. Only use the statement if the situation applies to you or your child. The form asks for minimal information to reduce risk and protect you. You do not need to share the identity of the abuser or the details of the abuse.

The statement works even if you are in the first months of a fixed-term lease. The early termination right overrides lease terms that would otherwise require you to stay. The landlord cannot charge you a penalty for leaving under this process. The landlord can apply your last month’s rent deposit to the rent due for your final month or partial month. You may owe a small pro-rated amount, or you may receive a refund, depending on dates and amounts.

If a dispute arises over the validity of your notice or the return of amounts, a legal process exists to resolve it. The protections and obligations described above are enforceable. Keep copies of everything you serve and all related communications.

How to Fill Out a Tenant’s Statement About Sexual or Domestic Violence and Abuse

Follow these steps to complete and use the statement correctly. Take your time. Accuracy and proper service matter.

1) Get the current form

Use the most recent version of the Tenant’s Statement. If you have an older copy, check that it matches current requirements. If in doubt, obtain a fresh copy. – Print clearly if you complete it by hand. Use black or blue ink.

2) Identify the tenancy and rental unit

Enter your full legal name as it appears on your lease or rental agreement. – Enter the full civic address of the rental unit. Include unit number, street, city, and postal code. – If your name has changed since you signed the lease, you can note your prior name in brackets.

3) Confirm your status as a tenant

The statement is for tenants. If you are not a tenant of record, you cannot use it. – If you are a parent of a child who experienced violence or abuse, state that the child lives with you.

4) Make the core statement

The form will ask you to confirm that you, or a child living with you, have experienced sexual or domestic violence or abuse. – It will ask you to confirm that you fear for your safety or your child’s safety in the rental unit. – Read the wording carefully and check the boxes or initial where indicated. The form is designed to avoid detail. Do not add facts unless the form asks for them.

5) Choose your documentation option

The statement itself is a permitted option. If you are using the statement, you do not need to attach a court order or professional letter. – If you have supporting documents and prefer to provide them, you can, but it is not required when you use this statement.

6) Confirm the linked notice to end your tenancy

The statement works together with your 28-day notice to end your tenancy due to sexual or domestic violence or abuse. – Prepare that notice at the same time. Choose a termination date at least 28 days after the landlord will receive your notice. – The termination date does not have to be the end of a month. Use a date that allows a safe move.

7) Confidentiality acknowledgments

The form will include information about confidentiality obligations. Review it. – You may be asked to confirm that you understand the landlord must keep this information confidential and that misuse has consequences.

8) Warnings about false statements

The form will warn that it is an offence to knowingly give false information. – Read and acknowledge this warning. Only use the form if the situation applies to you or your child.

9) Signature and date

Sign the statement. Print your name under your signature. – Date the form. The date should match, or be very close to, the date on your 28-day notice.

10) Optional contact information

You may choose to provide a mailing address for correspondence after you move. If you do, think carefully about safety. – If you prefer not to give a new address, you can give a safe mailing address for deposit refund and any final documents. Consider using a trusted third party or a P.O. Box if that is safer.

11) Attach the statement to your notice

Make a complete package that includes your 28-day notice and this statement. – Do not include other sensitive documents unless you choose to do so.

12) Make copies for your records

Make a full copy of the signed statement and the notice for yourself. – Keep them in a safe place. Consider storing a scan or photo in a secure location.

13) Serve the landlord

Deliver the notice and statement to your landlord using an allowed delivery method. Personal delivery, mail, courier, or another allowed method are common options. – If you live in a building, you can deliver to the landlord’s office or agent. Place the documents in a sealed envelope marked confidential. – Record how and when you delivered them. If you mailed them, keep the receipt. If you delivered by hand, note the date, time, and person who accepted them.

14) Plan for the termination date

You must pay rent up to the termination date. Your last month’s rent deposit will be applied to the final period. – If the termination date falls mid-month, you may owe or receive a pro-rated amount. Confirm the math with the landlord in writing. – Arrange your move, return of keys, and final inspection for the termination date or earlier by agreement.

15) Handle utilities and services

If utilities are in your name, schedule a shutoff or transfer for the termination date. – Update your address with banks, employers, and services once you have a safe mailing address.

16) If you have co-tenants or roommates

Your notice and statement end only your interest in the tenancy. The remaining tenants can continue if they wish. – If another tenant also needs to leave for safety, they should give their own notice supported by a permitted document or statement. – If all tenants plan to leave, coordinate with the landlord to handle the unit’s turnover and deposits.

17) Avoid common mistakes

Do not omit the signature or date. Unsigned statements can lead to disputes. – Do not forget to include the 28-day notice. The statement alone does not end the tenancy. – Do not set a termination date fewer than 28 days after the landlord will receive your notice. – Do not describe the abuse in detail on the form. The form is designed to protect your privacy.

18) What happens next

The landlord processes the termination and keeps your statement confidential. – You prepare to move. If you need to move before the termination date, discuss keys and access with the landlord. – After you move, return all keys. Provide a safe address for any refunds. Keep a copy of your move-out communication.

19) If the landlord asks for more information

You are not required to give details of the abuse or identify the abuser. – If your notice and statement are complete and were served properly, that is enough. – If the landlord refuses to accept the notice, put your position in writing. Keep records. You can pursue a remedy if needed.

20) If you want to withdraw your notice

If circumstances change and you want to stay, the landlord does not have to agree. – You can ask the landlord in writing to agree to continue the tenancy. Get any agreement in writing.

Practical example of completing the form:

• You fill in your name: “Taylor Singh.”
• You list the rental unit: “Unit 3B, 123 Main Street, Ottawa, ON, K1A 0A1.”
• You check the box confirming you are a tenant and that you fear for your safety because of sexual or domestic violence or abuse.
• You check the box confirming the person who experienced it is you (or your child).
• You sign and date the form.
• You prepare your 28-day notice. You choose a termination date 30 days ahead. You attach the signed statement.
• You hand-deliver the documents to the landlord’s office in a sealed envelope marked confidential. You note the date and time.
• You keep copies. You plan your move and key return for the termination date.

Final reminders:

• Use the statement only if it applies to you or your child who lives with you.
• Keep safety first. Consider who might have access to your mailbox or shared spaces.
• Keep everything short and factual. The form is designed for speed and privacy.
• If you need help choosing a termination date or serving the landlord, ask a trusted advisor.

Legal Terms You Might Encounter

Tenant’s Statement means this specific document where you confirm you experienced sexual or domestic violence or abuse. You use it to support your request to end your tenancy early. It is designed to protect your privacy. You should treat it as confidential and share it only with the landlord or their authorized agent.

Notice to End Tenancy refers to the separate companion notice you complete and serve with your Statement. The Notice sets the termination date and tells your landlord when you plan to move out. The Statement and the Notice work together. You need both for an early termination based on safety.

Termination date is the date your tenancy ends. You should choose a date that meets the legal notice period. Pick a realistic move‑out date. You are responsible for the unit and rent until that date unless you and your landlord agree otherwise.

Statutory notice period is the minimum lead time required between when you deliver your Notice and your termination date. The period is set by law. Count the days carefully. If you are unsure how to count, choose a later date to avoid a short-notice problem.

Co‑tenant or joint tenant means another adult who also signed your lease. Ending your tenancy early affects shared leases differently. Your Statement applies to you. The landlord and remaining tenants may need to address the lease after you leave. Make sure your Notice reflects whether you are ending only your interest or the tenancy for everyone, as allowed.

The landlord of record is the person or company legally responsible for the rental. It may be the property owner or a property manager. Serve the forms on the landlord of record or their agent, not just a concierge or a superintendent, unless they are authorized to accept documents.

Service and proof of service describe how you deliver your forms and how you prove delivery happened. Acceptable methods can include hand delivery, mail, courier, or electronic delivery if agreed. Always create a paper trail. Keep receipts, emails, tracking numbers, or a signed acknowledgment.

Supporting document means any extra material you might attach, such as a safety plan or a court or medical document. The Statement is designed to stand on its own. Do not attach sensitive documents if doing so could put you at risk. If you choose to include anything, remove personal identifiers that are not needed.

Confidential contact information is a safe way to reach you about the tenancy, such as an email you control or a mailing address that does not reveal your location. If you include contact details on the Notice, ensure they will not expose you to harm. You can note that communications about the Statement must remain confidential.

Withdrawal or rescission means taking back your Notice and Statement. If your situation changes and you want to stay, act fast. Make the withdrawal in writing. Get the landlord’s written agreement that your tenancy continues and confirm new terms in a signed document.

FAQs

Do you need a police report or court order to use the Tenant’s Statement?

No. The Statement exists so you can state what happened and end your tenancy early for safety. You can use it without attaching police or court records. Only include extra documents if you want to and if it is safe. Your signed Statement is a formal declaration. Keep it accurate and complete.

Do you still have to pay rent after you file the Statement?

You are responsible for the rent and the unit until the termination date on your Notice. After that date, the rent should stop for you. If you and your landlord agree to an earlier move‑out, put it in writing. If you paid a deposit, ask how it will be applied or refunded. Keep records of any agreement.

Can you end the lease if the person who harmed you is also a tenant?

You can end your own tenancy by using the Statement and the companion Notice. You cannot force another tenant off the lease through this form. After you leave, the landlord will handle the remaining lease with any co‑tenants. If you share rent or utilities, tell them in writing what date your responsibility ends.

How do you deliver the Statement to your landlord safely?

Use a method that creates proof and protects your location. Hand delivery to the landlord or their agent, mail, courier, or other agreed methods can work. If you deliver in person, bring a witness or ask for a signed receipt. If you deliver electronically, save the sent message and any read confirmations. Avoid delivery methods that could expose your new address.

What if your landlord ignores or rejects your Statement?

Keep calm and stick to your documentation. The Statement and Notice are formal legal documents. If you served them properly and set a valid termination date, proceed with your plan. Keep copies, proof of service, and any messages. If a dispute arises, your records will support you in any resolution process. Do not engage in unsafe or hostile conversations. Communicate in writing.

Can you retract the Statement if you change your mind?

Yes, if you act before the termination date and your landlord agrees. Put your withdrawal in writing and ask the landlord to confirm in writing that your tenancy continues. If you decide to stay after the termination date, you will likely need a new agreement. Keep a signed copy of any change.

Do you have to tell your landlord the details of the abuse?

No. The Statement does not require you to describe events in detail. It confirms that you meet the criteria to end your tenancy early for safety. Share only what the form asks for. Do not include medical details, private addresses, or information that could compromise your safety.

What if you have already moved out—should you still file the Statement?

Yes. Filing the Statement with the companion Notice creates a clear record that you ended the tenancy based on safety. It supports your confidentiality and clarifies your end date. Return all keys and fobs. Provide a safe forwarding address or email for final statements. Keep proof of delivery for your files.

Checklist: Before, During, and After

Before signing

Confirm the correct legal names for you, any co‑tenants, and the landlord of record. – Locate your lease to verify the unit address, lease start date, and all tenants listed. – Plan a termination date that meets the notice period and your move logistics. – Decide on a safe communication method and forwarding address or email. – Prepare the companion Notice to End Tenancy. You will serve it with the Statement. – Gather optional supporting documents only if safe and necessary. Remove sensitive details. – Choose a safe delivery method and how you will document proof of service. – Identify a safe place to store copies, separate from anyone who might access them. – If you share utilities or services, collect account numbers to update later.

During signing

Use your full legal name exactly as it appears on the lease. – Fill in the complete unit address, including unit number and postal code. – Enter a clear termination date that respects the notice period. – Review each section for completeness. Do not leave required fields blank. – Avoid including your new address on the forms. Use a safe contact instead. – Keep your description factual and minimal. The Statement does not require detailed evidence. – Initial or sign in every place the form requires. Date your signature. – Ensure your companion Notice contains the same termination date as the Statement. – Number pages and keep them together. Mark “Confidential” at the top if space allows.

After signing

Make two copies of the Statement and the companion Notice: one for you, one for delivery. – Serve the landlord of record or authorized agent using your chosen method. – Create and preserve proof of service: receipt, photo of delivery, tracking, or signed acknowledgment. – Confirm receipt in writing. Keep any response from the landlord with your records. – Set calendar reminders for the termination date and any move‑out steps. – Arrange safe movers, storage, and transportation. Plan to return keys on or before the termination date. – Notify shared service providers that you will stop responsibility on the termination date. Keep confirmations. – Store your originals in a safe, private location. Restrict access to anyone who should not see them. – If you need to correct an error, prepare an amended version and re‑serve promptly with a brief cover note.

Common Mistakes to Avoid

Don’t mismatch dates between the Statement and the companion Notice. A mismatch can cause confusion or give the landlord grounds to dispute timing. Double‑check that both forms show the same termination date.

Don’t set a termination date that is too soon. If you do, your landlord may treat the notice as invalid or push back on timelines. When in doubt, choose a later date and move earlier by agreement.

Don’t serve the wrong person. Delivering to a superintendent or concierge who is not authorized can delay or derail your notice. Identify the landlord of record or authorized agent and serve them directly.

Don’t include unsafe or unnecessary personal details. Sharing your new address or sensitive documents can increase risk and breach your privacy. Limit the information to what the form requires.

Don’t forget to keep proof of service. Without evidence of delivery, you may face disputes about notice timing or even extra rent claims. Save receipts, tracking numbers, and email confirmations.

Don’t rely on oral agreements alone. Verbal approvals can be misunderstood or denied later. Confirm any early move‑out date, key return, or deposit arrangements in writing.

What to Do After Filling Out the Form

Serve both documents together. Deliver the Tenant’s Statement and the companion Notice to the landlord of record or their authorized agent at the same time. Use a method that creates proof, such as hand delivery with a receipt, tracked mail, or a confirmed electronic method if permitted.

Record your proof immediately. As soon as you serve the documents, save the receipt or tracking number. If you delivered in person, write the date, time, location, and who you gave them to. Email yourself a summary while details are fresh.

Confirm receipt in writing. Send a short message stating that you served the Statement and the Notice, with the termination date included. Ask the landlord to reply acknowledging receipt. Save the reply.

Plan your move‑out. Book movers, storage, and transportation. Schedule the elevator if needed. Pack documents and valuables first. Do not post your move on social media. Aim to move out before or on the termination date.

Coordinate with co‑tenants. Tell co‑tenants your termination date in writing and how shared bills will be handled. Make it clear when your responsibility for rent and utilities ends. Keep the message factual and brief.

Handle keys and access items. Arrange where and when you will return keys, fobs, and parking passes. Get a key receipt. If you cannot meet in person safely, use a tracked method or an agreed locked drop‑box and request a written confirmation.

Close out accounts. Contact utility providers, internet, and other services. Provide the termination date and your safe forwarding email or mailing address. Request final bills and confirmations in writing.

Address deposits and final statements. Ask the landlord to confirm how any deposit will be applied or returned. Request an itemized statement if applicable. Keep copies of all financial documents.

Make corrections if needed. If you notice an error on the Statement or the Notice, prepare an amended version with the correct information. Mark it “Amended,” re‑serve it promptly, and keep proof. Send a brief cover note explaining the correction.

Withdraw only if safe and timely. If you decide to stay, send a written withdrawal before the termination date. Ask the landlord to confirm in writing that your tenancy continues and under what terms. Keep signed copies in your files.

Store your records securely. Keep copies of the Statement, the Notice, proof of service, landlord acknowledgments, and move‑out records for your personal file. Store them in a secure place that others cannot access.

If issues arise, use your documentation. If the landlord disputes your notice or requests extra rent beyond the termination date, rely on your dated forms and proof of service. Keep communications in writing. Seek guidance if needed and avoid any contact that could compromise your safety.