Application for Fireworks Operator Certificate - Visitor

Printable version – (PDF, 52 kb)

Please PRINT Clearly - Applicant fills out Sections A and B. Do not fill out Section C.

A. APPLICANT INFORMATION

Family Name _______________________________________

Given Name ____________________________________________

Date of Birth (yyyy/mm/dd) _______________________________

Mailing Address ____________________________________

City _______________________

Province/Territory __________________________________

Postal Code ________________

Telephone ________________

Fax __________________________

E-Mail __________________________

Organization (if related to fireworks/pyrotechnics special effects) _____________________

Signature of Applicant _____________________________

B. Type of Certificate requested

Check box for requested Fireworks Operator Certificate – visitor

  • Display – Visitor
  • Pyrotechnician - Visitor
  • For each certificate the applicant must submit:
    • the applicant’s work resume;
    • the list of the planned fireworks/pyrotechnics displays in Canada and their dates; and
    • the name, contact information and the number of the fireworks operator certificate of the Canadian supervisor in charge at each fireworks/pyrotechnics display.

Application Information

  • Fee is $150.00 per certificate;
  • To apply, mail application form, payment and one photo to the ERD region where the work will begin. Please note:
    • Form F17-03 must be completed and signed;
    • Payment must be made by certified cheque or money order payable to Receiver General for Canada; and
    • The photo must be taken within the last 12 months. Digital photos are acceptable. Once you have returned by mail your application and payment, you may email the digital file with your last name as the file name. (i.e., Smith.jpg) to the email address in your region with your name in the subject line.

Canada: (excluding Quebec)
580 Booth Street, Ottawa (ON) K1A 0E4
Tel. (613) 948-5200, Fax. (613) 948-5195, Email: canmet-erd@nrcan.gc.ca

Quebec:
P.O. Box 100, 2050 Girouard West, Saint-Hyacinthe (QC) J2S 7B2
Tel. (450) 773-3431, Fax. (450) 773-6226, Email: EasternRegion@nrcan.gc.ca

C. ERD APPROVALS (for office use only)

FINANCE

Cheque or Money Order No._________ Fee Paid: $ ______ Reference No._________

PYRO ID:

Certificate No.: ______________ Type: _________________ Expiry Date: ___________

Approved by: __________________________ Date: ___________________