Understanding the GS 121 Canada form is crucial for anyone looking to authorize a representative to act on their behalf in matters related to the Freedom of Information and Protection of Privacy Act. This form serves as a legal document whereby an individual, residing in a specific province, can designate another person located in the same or a different province to represent them. It is particularly important to note that the form allows for the specification of the rights to be exercised on the individual's behalf. These rights might encompass accessing all records containing personal information, specific categories of personal information, or other rights under the act, such as consenting to disclose personal information. Additionally, the form highlights the need for this authorization to be witnessed, necessitating a section for an affidavit of the witness, which further includes a declaration from the witness, their occupation, and a statement of their belief in the signer's legal age and understanding. This meticulous attention to detail ensures the form’s effectiveness and legality in granting the representative the authority to act under the Freedom of Information and Protection of Privacy Act, making it an essential tool for individuals looking to navigate the complexities of accessing and managing their personal information securely and effectively. The inclusion of provisions for the affidavit of the witness adds another layer of formal validation, ensuring that all procedures are thoroughly followed and the agreement is properly witnessed, thereby minimizing the potential for disputes or misunderstandings regarding the authorization granted through the GS 121 form.
| Question | Answer |
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| Form Name | Form Gs 121 Canada |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Authorizing, Oaths, 2001, affidavit of authorization |
Authorization of Representative
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authorize |
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living at |
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as my personal representative to act on my behalf, and to exercise: |
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(select one) |
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all my rights under the Freedom of Information and Protection of Privacy Act
my right to access all my records containing personal information in all categories of personal information
my right to access all of the following records containing personal information or all of the following categories of personal information (number and titles of records or categories):
the rights that I have under the Freedom of Information and Protection of Privacy Act regarding the following other matters (e.g. consent to disclose personal information):
I confirm that my representative has the authority to exercise the above right(s) under the Act for me.
This authorization will be in effect until
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in the presence of |
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Signature of Authorizing Person |
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Signature of Witness |
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(See Affidavit of Witness form to complete) |
GS 121 (2001/12) |
Page 1 of 2 |
Affidavit of Witness
CANADA
IN THE PROVINCE OF ALBERTA
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Name of the Witness in Full |
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Occupation of Witness |
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of |
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Complete Home Address of Witness |
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in the province of |
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, make oath and say that: |
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1. I was personally present and I saw |
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Name of Individual |
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sign the Authorization of Representative form to which this is attached. |
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2. The Authorization of Representative form was signed by |
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Name of Individual |
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and that I am the one who witnessed the form.
3.I know
18 years of age or older.
and I believe that he/she is
Name of Individual
Signature of Witness
Sworn before me at in the province of on
Commissioner for Oaths
Print Name |
Expiry Date of Commission |
GS 121 (2001/12) |
Page 2 of 2 |