NRCAN PHOTO IDENTIFICATION RENEWAL FORM 2012

This HTML document is not a form. It's purpose is to display the information as found on the forms for viewing purposes only and will not be accepted if used to apply with the NDT Certifying Agency. If you wish to submit a form, you must use only the PDF version.

When applying for NRCan photo identification card renewal please provide
2 passport photographs only, size 2 in x 2 ¾ in

Language: English ❏ Français ❏

Mr. □ Mrs. □ Ms □

Name(Surname/Given Names) ________________ /______________________

Card Reg #__________

Address___________________________________________________

City_____________ Province ______________ Postal Code___________

Tel. _____ _______________ Email: __________________________________

Date of Birth: YYYY________MM______DD______ Date: ___________________

Signature: (Please sign in the box below)

Present Employer: _____________________________________

Email: ________________________________

Address: ______________________________________________________

City: ___________________ Province: ___________Postal Code: __________________

Tel: _______________________________ Fax: ________________________

EMPLOYER/SUPERVISOR/SPONSOR VERIFICATION:
I attest that the information given on this form is accurate and the photographs attached are those of the applicant who signed this application form. NRCan may contact me to verify information related to this application.

Name: _____________________________ Signature: _________________________
(Please Print)

Date (YYYY/MM/DD): ______ /_____ /_____

Payable to Receiver General for Canada
**Personal cheques are not accepted for renewal**

Company Cheque □ Money Order □
Credit Card: □ Personal □ Company □ Visa/Mastercard □ Amex □

Cardholder Name_____________________________ Amount_______________________
(if personal/company name)

Card No. ____________________ Expiry Date____________

Signature:____________________________________________________

NDT Certifying Agency
CANMET-MTL, Natural Resources Canada
183 Longwood Road South
Hamilton, Ontario L8P 0A5

Tel.: 905-645-0653 or 1-866-858-0473
Fax: 905-645-0836

Email: NDT@NRCan.gc.ca