Show download pdf controls
  • Section H: Declaration

    Read the declaration. If it is correct, print your full name and position, then sign and date the declaration.

    Both declarations must be completed if you are a supplier of USM information, lodging the USM statement on behalf of the provider.

    If you are the provider lodging the USM statement, only complete the provider declaration.

    Before you sign the USM statement, check you have provided complete and accurate information. This statement will be returned to you if it is not signed.

    Last modified: 05 Sep 2019QC 21679