Government of Ontario: Ministry of Community and Social Services

Family Responsibility Office
PO Box 200 Stn A
Oshawa ON L1H 0C5

Cancellation of Third Party Authorization Form

Please complete this form to CANCEL Third Party Authorization on your case with the Family Responsibility Office (FRO).

A completed Cancellation of Third Party Authorization Form will STOP all third party access to your case file at FRO. Third Party Authorization can be set up again by completing a new Third Party Authorization Form.


I am the:
    

    
      
     Work Phone or Cell #      - 
 
 

My signature below indicates that I agree to the following:

  1. I understand that by completing and signing this form I am asking the FRO to CANCEL the Third Party Authorization Form that I previously sent to FRO and STOP the Third Party from having access to my case.

  2. I understand that once this Cancellation of Third Party Authorization Form is processed by FRO only I will receive or provide information to FRO concerning my case.

  3. I understand that I will be required to complete a new Third Party Authorization Form and send it to FRO before a third party is provided ANY information concerning my case with FRO.

  4. I understand that at FRO’s discretion, they may contact me by telephone to verbally confirm this Cancellation of Third Party Authorization Form before canceling the Third Party’s

Please sign and date below to complete the Cancellation of Third Party Authorization Form for the FRO.

Please return the completed form to FRO by Mail or FAX

FRO Client Signature:

 


Return Completed Forms by Mail:
Family Responsibility Office
PO Box 200 Stn A
Oshawa ON L1H 0C5

Return Completed Forms by Fax:
(416)-240-2401

FRO-015E (19/05/2004)

Version franšaise disponible

© Queen’s Printer for Ontario, 2008