Government of Ontario

Tribunals Ontario
Fire Safety Commission

15 Grosvenor St, Ground Fl
Toronto ON  M7A 2G6
Telephone: 416-326-1356 / 1-888-777-3616
Teletypewriter (TTY): 1-800-855-0511
Fax: 416-314-4270 / 1-800-720-5292
Website: tribunalsontario.ca/fsc
Email: FSCregistrar@ontario.ca

Notice of Withdrawal

Important Information

• If you do not want to continue with your appeal, use this form to provide written notice of your withdrawal to the Commission and to the other party to the appeal.
• If you withdraw your appeal, no hearing before the Commission will take place and your appeal file will be closed.

1. Notice of Withdrawal

I, the Appellant

Last Name
First Name
Middle Initial

withdraw my appeal before the Commission. I understand that by withdrawing my appeal, no further hearings will be held and that my file with the Commission will be closed.

2. Copy to Respondent

I have sent a copy of this Notice of Withdrawal to the Respondent or their representative.

at the following fax number or address

Address Notice of Withdrawal was delivered to

Unit Number
Street Number
Street Name
PO Box
City/Town/Municipality
Province   AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon
Postal Code

Fax Number or Email Address Notice was sent to

3. Signature

Name

Signature


Date (yyyy/mm/dd)

The Fire Safety Commission collects the personal information requested on this form under sections 26, 33, and 36 of the Fire Protection and Prevention Act, 1997. This information is being collected for the purpose of conducting a proceeding before the FSC. Any questions about this collection may be directed to the Fire Safety Commission at 416-326-1356 or toll-free at 1-888-777-3616 or teletypewriter (TTY) at 1-800-855-0511.