Government of Yukon

Community Services

A to Z forms

 Builders Lien Act

 Form 1 - Builders Lien Act - Claim of Lien for Materials or Machinery Placed or Furnished
         Bilingual PDF (YG6237)

 Form 2A - Builders Lien Act - Claim of Lien for Wages for Work Done (Single Claimant)
         Bilingual PDF (YG6238)

 Form 2B - Builders Lien Act - Claim of Lien for Wages for Work Done (Multiple Claimants)
         Bilingual PDF (YG6239)

 Form 3 - Builders Lien Act - Receipt for Discharge of Lien
         Bilingual PDF (YG6240)

 Form 4 - Builders Lien Act - Affidavit Verifying Claim of Lien or Discharge
         Bilingual PDF (YG6241)


 Building Safety 

 Affidavit of Manufacturer for Cast Iron Boilers or Pressure Vessels
         English PDF (YG5399)

 Confirmation of Assurance of Professional Design and Commitment for Field Review
         English PDF (yg5734)

 Application for a Pressure Welder's Certificate of Qualification
         Bilingual PDF (YG5402)

 Application for Development Permit
         Bilingual PDF (YG5982)

 Elevating Devices Application for Contractor's Licence
         Bilingual PDF (YG5406)

 Application for Building Permit
         Bilingual PDF (YG5981)

 Electrical Permit Application
         Bilingual PDF (YG5401)

 Application for Plumbing Permit
         Bilingual PDF (YG5983)

 Elevating Devices Application Renewal of Contractor's Licence
         Bilingual PDF (YG5403)

 Electrical Contractor Declaration Form
         Bilingual PDF (YG4059)

 Yukon Gas Burning Devices Act - Temporary Use Authorization Form
         Bilingual PDF (YG5991)

 Registration Information (Confidential) Elevator Inspections
         English PDF (YG5426)


 Building, Development & Plumbing 

 Installers Declaration of Completion (Initial or Alteration) - Elevators, Escalators, Dumbwaiters, Moving Walks, Freight Platform Lifts
         Bilingual PDF (YG5405)

 Installers Declaration of Completions (Initial or Alteration) - Handicap Lifts, Manlifts, Passenger Ropeways, Amusement Rides, Personnel Hoists
         Bilingual PDF (YG5407)

 Gas Permit Application
         Bilingual PDF (YG4271)


 Business Corporation Act ***Effective May 1, 2015*** 

 Form 1 - Business Corporations Act - Articles of Incorporation
         Bilingual PDF (YG6119)

 Form 2 - Business Corporations Act - Notice of Address of Corporation
         Bilingual PDF (YG6120)

 Form 3 - Business Corporations Act - Notice of Change or Address of Corporation
         Bilingual PDF (YG6121)

 Form 4 - Business Corporations Act - Notice of Change of Address of Corporation (by person who maintains registered or records office)
         Bilingual PDF (YG6122)

 Form 5 - Business Corporations Act - Notice of Resignation of Person who Maintains Registered or Records Office.
         Bilingual PDF (YG6123)

 Form 7 - Business Corporations Act - Articles of Amendment
         Bilingual PDF (YG6124)

 Form 8 - Business Corporations Act - Notice of Directors
         Bilingual PDF (YG6125)

 Form 9 - Business Corporations Act - Notice of Change of Directors and Directors’ Addresses (Yukon Corporation)
         Bilingual PDF (YG6126)

 Form 10 - Business Corporations Act Business Corporations Regulation - Notice of Shareholders Notice of Change of Shareholders and Shareholders’ Addresses
         Bilingual PDF (YG6127)

 Form 11 - Business Corporations Act - Restated Articles of Incorporation
         Bilingual PDF (YG6128)

 Form 12 - Business Corporations Act - Articles of Amalgamation
         Bilingual PDF (YG6129)

 Form 13 - Business Corporations Act - Application for Authorization to Amalgamate with Extra-Territorial Body Corporate into Another Jurisdiction
         Bilingual PDF (YG6130)

 Form 14 - Business Corporations Act - Articles of Continuance
         Bilingual PDF (YG6131)

 Form 15 - Business Corporations Act - Application for Authorization to Continue into Another Jurisdiction
         Bilingual PDF (YG6132)

 Form 16 - Business Corporations Act - Articles of Reorganization
         Bilingual PDF (YG6133)

 Form 17 - Business Corporations Act - Articles of Arrangement
         Bilingual PDF (YG6134)

 Form 18 - Business Corporations Act - Articles of Revival
         Bilingual PDF (YG6135)

 Form 19 - Business Corporations Act - Articles of Dissolution (special case)
         Bilingual PDF (YG6136)

 Form 20 - Business Corporations Act - Statement of Intent to Dissolve (unsupervised liquidation)
         Bilingual PDF (YG6137)

 Form 22 - Business Corporations Act - Statement of Revocation of Intent to Dissolve
         Bilingual PDF (YG6138)

 Form 23 - Business Corporations Act - Articles of Dissolution (after unsupervised liquidation)
         Bilingual PDF (YG6139)

 Form 25 - Business Corporations Act - Annual Return of Yukon Corporation
         Bilingual PDF (YG6140)

 Form 26 - Business Corporations Act - Statement for Registration as an Extra-Territorial Corporation
         Bilingual PDF (YG6141)

 Form 27 - Business Corporations Act - Appointment of Attorney for Service and Alternative Attorney of Extra-Territorial Corporation
         Bilingual PDF (YG6142)

 Form 28 - Business Corporations Act - Application for Cancellation of Assumed Name of Extra-Territorial Corporation
         Bilingual PDF (YG6143)

 Form 31 - Business Corporations Act - Notice of Change of Address for Attorney For Service of Extra-Territorial Corporation
         Bilingual PDF (YG6144)

 Form 32 - Business Corporations Act - Notice of Change of Statement for Registration as an Extra-Territorial Corporation (for changes other than directors¹ names or addresses)
         Bilingual PDF (YG6145)

 Form 33 - Business Corporations Act - Notice of Change of Directors and Directors¹ Addresses (extra-territorial corporation)
         Bilingual PDF (YG6146)

 Form 35 - Business Corporations Act - Statement of Amalgamation of Extra-Territorial Corporation Effected in Another Jurisdiction
         Bilingual PDF (YG6147)

 Form 36 - Business Corporations Act - Annual Return of Extra-Territorial Corporation
         Bilingual PDF (YG6148)

 Form 37 - Business Corporations Act - Statement for Registration as an Extra-Territorial LLC
         Bilingual PDF (YG6149)

 Form 38 - Business Corporations Act - Appointment of Attorney for Service and Alternative Attorney of Extra-Territorial LLC
         Bilingual PDF (YG6150)

 Form 39 - Business Corporations Act - Application for Cancellation of Assumed Name of Extra-Territorial LLC
         Bilingual PDF (YG6151)

 Form 42 - Business Corporations Act - Notice of Change of Addresses of Attorney for Service of Extra-Territorial LLC
         Bilingual PDF (YG6152)

 Form 43 - Business Corporations Act - Notice of Change to Statement for Registration as an Extra-Territorial LLC
         Bilingual PDF (YG6153)

 Form 44 - Business Corporations Act - Notice of Change of Managers and Managers¹ Addresses (extra-territorial LLC)
         Bilingual PDF (YG6154)

 Form 46 - Business Corporations Act - Statement of Amalgamation of Extra-Territorial LLC Effected in Another Jurisdiction
         Bilingual PDF (YG6155)

 Form 47 - Business Corporations Act - Annual Return of Extra-Territorial LLC
         Bilingual PDF (YG6156)

 Application for Name Reservation
         Bilingual PDF (YG6212)


 Business Name Registration *** Please refer to forms under the Partnership and Business Name Act*** 


 Chiropractor Act 

 Application for Chiropractor
         Bilingual PDF (YG5090)

 Renewal for Chiropractor
         Bilingual PDF (YG5126)


 Consumer Protection Act 

 Application for Collection Agency
         Bilingual PDF (5094)

 Application for Collection Agency Employee
         Bilingual PDF (5093)

 Renewal for Collection Agency
         Bilingual PDF (yg5125)

 Renewal for Collection Agents Employee
         Bilingual PDF (yg5117)


 Dental Professions Act 

 Application for Dentist
         English French PDF (YG5097)

 Application Dental Hygienist
         English French PDF (YG5095)

 Application for Dental Therapist
         English French PDF (YG5096)

 Application for Registration of a Professional Corporation
         Bilingual PDF (YG5100)

 Application for Specialist Dentist
         English French PDF (YG5769)

 Renewal for Dentist and Specialist Dentist
         English French PDF (YG5056)

 Renewal for Dental Hygienist
         English French PDF (YG5058)

 Renewal for Dental Therapist
         English French PDF (YG5060)

 Renewal for Professional Corporation - Dental
         Bilingual PDF (YG5057)


 Denturist Act

 Application for Denturist
         English French PDF (yg5098)

 Renewal for Denturist
         English French PDF (yg5059)


 Election 

 Affidavit of Printer
         Bilingual PDF (YG3630)

 Authorization of Agent
         Bilingual PDF (YG3634)

 Notice of Application for Revision
         Bilingual PDF (YG4441)

 Nomination Paper
         Bilingual PDF (YG3626)

 Poll Book
         Bilingual PDF (YG3635)

 Special Ballot Application and Oath
         Bilingual PDF (YG4868)

 Application for Registration
         Bilingual PDF (YG3628)

 Tally Sheet
         Bilingual PDF (YG4442)

 Revised List of Electors Certificate of Board of Revision
         Bilingual PDF (YG3631)

 Appointment of Election Officer
         Bilingual PDF (YG3632)

 Ballot Account
         Bilingual PDF (YG4443)

 Oath of Allegiance
         Bilingual PDF (YG5197)

 Advance Poll Oath
         Bilingual PDF (YG3633)

 Oath of a Challenged Elector
         Bilingual PDF (YG3629)

 Oath of a Member of the Board of Revision
         Bilingual PDF (YG3627)

 Oath of Witness
         Bilingual PDF (YG4440)

 Oath of Office
         Bilingual PDF (YG5196)


 Employment Standards 

 Complaint Information Form
         English French PDF (YG5600)

 Complaint Information Form Tip Sheet
         English French PDF (in5600)


 Fire Marshal’s Office 

 Application for a Storage Tank System Permit
         English French PDF (yg4648)

  Application for Residential Abandonment / Removal of Fuel Storage
         English French PDF (YG5725)


 Funeral Directors Act 

 Application for Funeral Director
         Bilingual PDF (YG5089)

 Renewal for Funeral Director
         Bilingual PDF (YG5127)


 Garage Keepers Lien Act

 Notice
         Bilingual PDF (YG6277)


 Home Owners Grant 

  Home Owners Grant
         Bilingual PDF (YG3101)


 Insurance Act 

 Canadian Council of Insurance Regulators - Application for Insurer's Licence
         English French PDF (External Link)

 Application for Broker
         Bilingual PDF (YG5190)

 Application for Special Broker
         Bilingual PDF (YG5120)

 Application for Adjuster
         Bilingual PDF (YG5318)

 Application for Salesperson
         Bilingual PDF (YG5123)

 Notice of Appointment of Salesperson - Page 4
         Bilingual PDF (YG5835)

 Renewal for Agent
         Bilingual PDF (YG5130)

 Monthly Return of Special Insurance Broker - Section 238(1)
         Bilingual PDF (YG5121)

 Agent recommendation
         Bilingual PDF (YG5084)

 Application for Agent
         Bilingual PDF (YG5084)

 Renewal for Insurance Company
         Bilingual PDF (YG5310)

 Renewal for Broker and Special Brokers
         Bilingual PDF (YG5322)

 Renewal for Adjuster
         Bilingual PDF (YG5134)

 Renewal for Salesperson
         Bilingual PDF (YG5129)

 Fee Schedule for Insurance
         Bilingual PDF (YG5088)


 Licensed Practical Nurses

 Renewal Application for Full and Interim Registration Licences - Licensed Practical Nurses
         English French PDF (yg5146)

 Inactive Application for New Inactive Registration Licences and Renewal of Inactive Registration Licenses - Licensed Practical Nurses
         English French PDF (YG6101)


 Lottery Licencing Act 

 Single day (7 hour) Raffle Terms and Conditions
         English French PDF (yg5730)

 Accountant Option Declaration
         English French PDF (yg5731)

 Statutory Declaration - Meals
         English French PDF (yg5715)

 Application for Bingo Licence
         English French PDF (YG5091)

 Application for Casino Games
         Bilingual PDF (YG5092)

 Application for a Raffle Licence
         English French PDF (YG5101)

 Sample Bingo Control Sheets
         English French PDF (yg5714)

 Raffle Ticket Inventory Control Worksheet
         English French PDF (yg5759)

 Prize Guarantee by Financial Institution
         English French PDF (yg5713)

 Prize Guarantee by Individual
         English French PDF (yg5712)

 Request for Travel Itinerary Form - Lottery Licensing Act
         English French PDF (YG5103)

 Financial Report for Bingo
         English French PDF (YG5338)

 Financial Report for Casino Games
         English French PDF (YG5340)

 Financial Report for Raffle
         English French PDF (YG5339)

 Sample Raffle ticket format
         English French PDF (N/A)


 Marriage Act 

 List of Clergymen Authorized to Solemnize Marriage
         Bilingual PDF (YG5055)


 Medical Profession Act 

 Renewal for Professional Corporation - Medical
         Bilingual PDF (YG5116)


 Naming Regulation ***Effective May 1, 2015***

 Form 1 - Naming Regulation - Application for Name Registration
         Bilingual PDF (YG6212)


 Optometrists Act 

 Application for Optometrist
         Bilingual PDF (YG5308)

 Renewal for Optometrist
         Bilingual PDF (YG5192)


 Partnership and Business Names Act ***Effective May 1, 2015*** 

 Form 1 - Partnership and Business Names Act - Notice of Office of Limited Partnership
         Bilingual PDF (YG6189)

 Form 2 - Partnership and Business Names Act - Notice of Change of Registered Office of Limited Partnership
         Bilingual PDF (YG6190)

 Form 3 - Partnership and Business Names Act - Application for Registration of Limited Partnership Formed Outside Yukon
         Bilingual PDF (YG6191)

 Form 4 - Partnership and Business Names Act - Declaration of Partnership
         Bilingual PDF (YG6192)

 Form 5 - Partnership and Business Names Act - Renewal of Declaration of Partnership
         Bilingual PDF (YG6193)

 Form 6 - Partnership and Business Names Act - Notice of Change of Information in Declaration of Partnership
         Bilingual PDF (YG6194)

 Form 7 - Partnership and Business Names Act - Declaration of Dissolution of Partnership
         Bilingual PDF (YG6195)

 Form 8 - Partnership and Business Names Act - Declaration of Business Name
         Bilingual PDF (YG6196)

 Form 9 - Partnership and Business Names Act - Notice of Change of Information in Declaration of Business Name
         Bilingual PDF (YG6197)

 Form 10 - Partnership and Business Names Act - Renewal of Declaration of Business Name
         Bilingual PDF (YG6198)

 Form 11 - Partnership and Business Names Act - Declaration of Cessation of Use of Business Name
         Bilingual PDF (YG6199)

 Form 12 - Partnership and Business Names Act - Application for Registration as an LLP
         Bilingual PDF (YG6200)

 Form 14 - Partnership and Business Names Act - Notice of Change of Information in Application for Registration as LLP
         Bilingual PDF (YG6201)

 Form 15 - Partnership and Business Names Act - Renewal of Registration as LLP
         Bilingual PDF (YG6202)

 Form 16 - Partnership and Business Names Act - Request to Cancel Status as LLP
         Bilingual PDF (YG6203)

 Form 17 - Partnership and Business Names Act - Statement from Governing Body of a Prescribed Profession
         Bilingual PDF (YG6204)

 Form 18 - Partnership and Business Names Act - Annual Report Limited Partnership Formed In Yukon
         Bilingual PDF (YG6205)

 Form 19 - Partnership and Business Names Act - Annual Report Limited Partnership Formed Outside Yukon
         Bilingual PDF (YG6206)

 Application for Name Reservation
         Bilingual PDF (YG6212)


 Pawnbrokers and Secondhand Dealers Act 

 Application for Pawnbroker and Secondhand Dealers
         Bilingual PDF (YG5135)

 Renewal for Pawnbrokers and Secondhand Dealers
         Bilingual PDF (YG5128)


 Personal Property Security Act ** Note: Yukon has moved to the ACOL Personal Property Registry System on June 27, 2016. For more info, visit: http://www.community.gov.yk.ca/corp/ppr.html** 


 Pharmacists Act 

 Application for Pharmacists
         Bilingual PDF (YG5061)


 Physiotherapist Act

 Renewal Application for Full, Interim and Inactive Registration Licences - Physiotherapists
         English French PDF (YG6087)


 Private Investigators and Security Guards Act 

 Application for Agency Private Investigation and Security Guard
         Bilingual PDF (YG5141)

 Application for Agent Private Investigation and Security Guard
         Bilingual PDF (YG5391)

 Renewal for Agency Private Investigation and Security Guard
         Bilingual PDF (YG5390)

 Renewal for Agent Private Investigation and Security Guard
         Bilingual PDF (YG5124)


 Professional Licensing & Regulatory Affairs 

 Credit Card Information
         English French PDF (YG5924)


 Real Estate Agents Act 

 Application for Real Estate Salesperson
         Bilingual PDF (YG5368)

 Renewal Application for Agent Real Estate
         Bilingual PDF (YG5137)

 Renewal for Salesperson Real Estate
         Bilingual PDF (YG5194)


 Recycling

 Application to be Registered as a Depot
         English French PDF (yg4163)

 Dealer’s monthly returns (Beverage Container Regulations)
         English French PDF (YG4159)

 Beverage Container Regulation Daily Cash Count Sheet
         English French PDF (YG4245)

 Recycling Processor Claim
         English French PDF (YG4732)

 Beverage Containers Purchases
         English French PDF (YG4241)

 Designated Materials Regulation - Application for Registration - Tires
         English PDF (YG6320)

 Beverage Container Regulation - Application for Registration
         English PDF (YG6319)


 Residential Landlord and Tenant Act

 1-Month Notice to End Tenancy From Tenant to Landlord for a Monthly Tenancy
         English French PDF (YG6033)

 2-Month Notice to End Tenancy From Landlord to Tenant for a Monthly Tenancy
         English French PDF (YG6034)

 3- Month Notice to End Tenancy for Yearly Tenancy
         English French PDF (YG6035)

 14 Day Notice to End Tenancy
         English French PDF (YG6036)

 Tenancy Agreement
         English French PDF (YG6037)

 Declaration of Service - Landlord Serving Tenant
         English French PDF (YG6039)

 Declaration of Service - Tenant Serving Landlord
         English French PDF (YG6038)

 Fee Waiver Application
         English French PDF (YG6040)

 Application for Dispute Resolution
         English French PDF (YG6031)

 Condition Inspection Report
         English French PDF (YG6032)


 Society Act ***Effective May 1, 2015*** 

 Form 1 - Society Act - Application for Incorporation of a Society
         Bilingual PDF (YG6164)

 Form 2 - Society Act - Notice of Change of Directors and Officers
         Bilingual PDF (YG6165)

 Form 3 - Society Act - Declaration of Category C Society
         Bilingual PDF (YG6166)

 Form 4 - Society Act - Notice of Change of Registered Address and/or Place Where Operations are Carried
         Bilingual PDF (YG6167)

 Form 5 - Society Act - Notice of Fiscal Year-end of Society
         Bilingual PDF (YG6168)

 Form 6 - Society Act - Annual Report of Yukon Society
         Bilingual PDF (YG6213)

 Form 9 - Society Act - Articles of Revival
         Bilingual PDF (YG6169)

 Form 11 - Society Act - Statement for Registration as an Extra-Territorial Society
         Bilingual PDF (YG6170)

 Form 12 - Society Act - Appointment of Attorney for Service of Extra-Territorial Society
         Bilingual PDF (YG6171)

 Form 13 - Society Act - Application for Cancellation of Assumed Name of Extra-Territorial Society
         Bilingual PDF (YG6172)

 Form 15 - Society Act - Notice of Change of Address of Attorney for Service of an Extra-Territorial Society
         Bilingual PDF (YG6173)

 Form 16 - Society Act - Annual Report of Extra-Territorial Society
         Bilingual PDF (YG6214)

 Form 18 - Society Act - Declaration of Category C Extra-Territorial Society
         Bilingual PDF (YG6174)

 Form 19 - Society Act - Notice of Fiscal Year-end of an Extra-Territorial Society
         Bilingual PDF (YG6175)

 Application for Name Reservation
         Bilingual PDF (YG6212)


 Solid Waste

 Application for a Permit for a Solid Waste Disposal Facility or Commercial Dump
         English French PDF (yg5705)


 Sports and Recreation

 YRAC Grant Application - Yukon Special Recreation Groups
         English PDF (YG6060)

 YRAC Grant Application - Sport Groups
         English PDF (YG6052)

 YRAC & YS4L Profile Information Form
         English PDF (YG6051)

 YS4L Grant Application
         English PDF (YG6063)

 Yukon High Performance - Athlete Assistance Program
         English PDF (YG6043)

 Yukon High Performance - Officials Program
         English PDF (YG6047)


 Storage Tanks 

 Application for a Storage Tank System Permit
         English French PDF (yg4648)

  Application for Residential Abandonment / Removal of Fuel Storage
         English French PDF (yg5725)


 Water 

 Water Delivery Request Form
         English French PDF (YG6260)

 Water Well Drillers Form
         English PDF (YG5302)


 Yukon Public Libraries 

 Yukon Public Libraries Request
         Bilingual PDF (YG3264)