"Replacement Certificate Request Form" - British Columbia, Canada

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Download "Replacement Certificate Request Form" - British Columbia, Canada

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Replacement Certificate
Request Form
You may request a replacement certificate only if you are a Ministry of Education certificate holder (that is, you
have paid the current year’s annual fee). If your certificate has expired, or if it has been suspended or cancelled
for any reason, we will provide you with a letter confirming your past certification instead of a replacement
certificate. This letter will indicate the validity dates of the certificate and the reason that the certificate is no
longer valid. The processing fee for a replacement certificate or confirmation letter is $35.00 (see page 2 for
payment options). We will send the certificate or letter to you only. We will not send it to a third party, nor can a
third party request it on your behalf. Once you have the replacement certificate or confirmation letter, you may
make copies of the document for any agencies that require it. When you have completed this form, you may
submit it to us by mail or by fax at 604 775-4859.
YOUR INFORMATION
Date of Birth
File/Certificate No.
(YYYY/MM/DD)
Given Names
Surname
Previous Surnames
Mailing Address
Home Telephone Number
Work Telephone Number
Email Address
(include area code)
(include area code)
CERTIFICATE INFORMATION
The certificate type for which I am requesting a replacement is a __________________________________
(Professional, Basic, Subject-Restricted, etc.) certificate.
I hereby request that the Ministry of Education send this replacement certificate or confirmation letter to me at
the above address.
Signature
Date Signed
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
Replacement Certificate
Request Form
You may request a replacement certificate only if you are a Ministry of Education certificate holder (that is, you
have paid the current year’s annual fee). If your certificate has expired, or if it has been suspended or cancelled
for any reason, we will provide you with a letter confirming your past certification instead of a replacement
certificate. This letter will indicate the validity dates of the certificate and the reason that the certificate is no
longer valid. The processing fee for a replacement certificate or confirmation letter is $35.00 (see page 2 for
payment options). We will send the certificate or letter to you only. We will not send it to a third party, nor can a
third party request it on your behalf. Once you have the replacement certificate or confirmation letter, you may
make copies of the document for any agencies that require it. When you have completed this form, you may
submit it to us by mail or by fax at 604 775-4859.
YOUR INFORMATION
Date of Birth
File/Certificate No.
(YYYY/MM/DD)
Given Names
Surname
Previous Surnames
Mailing Address
Home Telephone Number
Work Telephone Number
Email Address
(include area code)
(include area code)
CERTIFICATE INFORMATION
The certificate type for which I am requesting a replacement is a __________________________________
(Professional, Basic, Subject-Restricted, etc.) certificate.
I hereby request that the Ministry of Education send this replacement certificate or confirmation letter to me at
the above address.
Signature
Date Signed
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
Replacement Certificate
Request Form
Page 2/2
PAYMENT INFORMATION
If you wish to pay the processing fee by credit card, please complete the authorization form below. Otherwise,
please enclose a cheque or money order payable to the Minister of Finance.
Name of individual or business as it appears on the card:
Please choose one:
Visa
MasterCard
American Express
Credit Card Number
Expiry Date (MM/YY)
Total Payment Authorized
$35.00
Signature of card holder:
Date (YYYY/MM/DD)
Please note: Credit card data should not be emailed. The credit card information provided on this form will not be
retained. Upon authorization of the payment request, all credit card information will be destroyed.
May 2015
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
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