NRCan photo Identification Renewal Form

This HTML document is not a form. Its 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 Natural Resources Canada (NRCan) National Non-Destructive Testing Certification Body (NDTCB). If you wish to submit a form, you must use only the PDF version, (142 kb).

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When applying for NRCan NDTCB photo identification card renewal please provide 2 passport photographs.

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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)

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Present Employer: _____________________________________

Email: ________________________________

Address: ______________________________________________________

City: ___________________ Province: ___________Postal Code: __________________

Tel: _______________________________ Fax: ________________________

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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): ______ /_____ /_____

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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:____________________________________________________

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NRCan National Non-Destructive Testing Certification Body
Canmet-MATERIALS,
183 Longwood Road South
Hamilton, Ontario L8P 0A5
Tel.: 905-645-0653 or 1-866-858-0473
Fax: 905-645-0836
Email: Contact the NDT Office