Licence Appeal Tribunal
PO Box 250
Toronto ON M7A 1N3
Toll Free: 1-844-242-0608
Toll Free: 1-844-618-2566
In the matter of Licence Appeal Tribunal file number
Licence Appeal Tribunal file No.
I, the Appellant
Appellant Name: Last Name
Appellant Name: First Name
withdraw my appeal before the Tribunal. I understand that, by withdrawing my appeal, my file will be closed and my rights to a
hearing before the Tribunal in this matter will be terminated.
I have sent a copy of this Notice of Withdrawal to the Respondent, or their representative,
Name of Respondent or their Representative: Last Name
Name of Respondent or their Representative: First Name
at the following facsimile No. / address
Street No. and Name, Unit No.
or Facsimile Number of Withdrawal was delivered to
The Licence Appeal Tribunal collects the personal information requested on this form under section 3 of the Licence Appeal Tribunal Act, 1999. This information will be used to determine appeals under this Act. After an appeal is filed, all information may become available to the public. Any questions about this collection may be directed to the Licence Appeal Tribunal at 416-327-6500 or toll-free at 1-844-242-0608
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