Fillable Change Notice Form 2 Edited

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Change Notice Form 2 Edited

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Notice for Changes Form
The Retirement Homes Act, 2010 (Section 109 1 and 2 ) requires all retirement home licensees to
notify the RHRA of changes to the information in the licence application (including any supporting
documentation) or information on the Retirement Home Database.
Two months notice:
Licensees must notify the RHRA in writing, at least two months before any of the following changes
occur (or as soon as practicable):
▪ Any person ceases to have a controlling interest in the licensee
▪ A person acquires a controlling interest in the licensee
▪ Any other event that would result in the termination of the licence
To notify the RHRA of a change to persons with a controlling interest, please complete and submit a
Notice of Change of a Controlling Interest in a Licensee, available on the RHRA website.
Immediate notice:
Licensees must notify the RHRA in writing, as soon as possible after any of the following changes
occur:
▪ A change to the name, address and/or contact information of the licensee
▪ A change to the primary contact person for the licensee and their contact information
▪ A change to the name/address of the retirement home
▪ A change in the directors or officers of the licensee
▪ A change in the directors or officers of a person with controlling interest in the licensee
▪ A change in the person employed or retained to manage the operations or most of the
operations of the retirement home and their contact information
▪ A change to the number and/or location of automatic sprinklers in each resident’s room
and other areas of the retirement home
▪ An increase or decrease in the number of residents the retirement home can
accommodate
▪ A change to the care services that the licensee makes available to the residents
▪ A material change in any other information that was provided to the Registrar in
support of the licence application, for example:
o Disclosure of information in a corporate or individual personal history report,
including information about licenses and registration certificates, and/or orders
and offences
To notify the RHRA of a change under section 109(2) of the Act, please complete and submit the Notice
of Change Form on Page 3 and on our website http://rhra.ca/assets/en/pdf/Notice-of-Change-Form--
2014-04-21.pdf.
How to submit your Notice of Change Form:
By mail:
Retirement Homes Regulatory Authority
55 York Street, Suite 700
Toronto, ON
M5J 1R7
Or email to: info@rhra.ca
Notice for Changes Form
Please complete the table below and return to the RHRA by mail or email.
Submitted for:
Licence number:
Name of retirement home:
Address of retirement home:
Date of Change:
Date of Submission:
Changes to information
Type of Change
Original Information
EXAMPLE:
Day-to-day Operator
Phone number
John Smith
416-666-6666
Submitted By:
Name:
Position:
Phone number:
Email address:
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Change Notice Form 2 Edited

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Completed 16 July 2020

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