Declaration
Province of Québec,
District of
THE—(name of company)
The (name of company) was incorporated in (name of the country, province, etc.,) by letters patent (or as the case may be) granted, (or registered, as the case may be) on the (date).
Its principal place of business in Québec is at (name of town, etc.).
In testimony whereof, this declaration in duplicate is made and signed by me, (name, address and calling), the president, (principal manager, or chief agent, as the case may be) of the said company, at (name of place) on the (date).