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CERTIFIED IDENTITY CONFIRMATION

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Certifying official’s
Current legal name (given name(s) and surname): ________________________________________________________
seal or stamp
3OHDVHSULQWFOHDUO\ (in
Date of birth: 19___ ___ / ___ ___ / ___ ___ ENGLISH or
( yy / mm / dd ) FRENCH) must
&HUWLI\LQJ2I¿FLDO: cover only a portion
I certify that, on the date set forth below, the individual named on this form did appear of the photo.
personally before me and that I did identify this individual by: (a) comparing his/her
physical appearance with the photograph on the valid government-issued identifying
GRFXPHQWV SUHVHQWHG E\ WKH LQGLYLGXDO DQG ZLWK WKH SKRWRJUDSK DI¿[HG KHUHWR Candidate photo
and (b) comparing the individual’s signatures made in my presence on this form WREHFHUWL¿HG
with the signature on his/her valid government-issued identifying document(s). The CER
Firmly attach one
statements in this document are subscribed and sworn before me by the individual on L• T
photograph here.

IF
AL SE

Y I N G OF
this day, in the month of , in the year 20 __ __. See below for photograph
Certifying official must UHTXLUHPHQWV

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In my capacity as: write the CURRENT date. L FIC
IAL •

At: All information

must be provided
Name: by the certifying
official.
Signature:

Telephone:
Applicants MUST sign here.
Email: .
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7KHVHDORUVWDPS0867EHLQENGLISH OR FRENCH.
Candidate’s signature
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Candidate: Please attach a second identical photograph, which To be

willleft
be scanned
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E\WKH0&&DQGXVHGIRUH[DPLQDWLRQDQGRUVRXUFHYHUL¿FDWLRQUHTXHVWSXUSRVHV Candidate photo
as applicable. STUDENT (DO NOT CERTIFY):
applicants.
MCC Candidate Code (if available): Attach a second
identical photograph here
with one piece of scotch tape
Photograph Requirements: along the top edge.
Second Do not tape over the face.
 0XVWEHFXUUHQWLHWDNHQZLWKLQWKHSDVWVL[PRQWKV identical photo Do not have this photograph
 Must be colour (black and white photos are not accepted). required here This second
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ZLGHE\PPLQFKHVORQJ one piece certified; ONLY
of scotch tape. the above photo.
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contrasting background. Scanned photographs are not
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Applicants MUST sign here.

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Candidate’s signature
 SAMPLE ONLY
DO NOT CERTIFY THIS SAMPLE
CERTIFICATION OF PASSPORT

Certifying official’s
contact information.
Mr./Ms. Certifying Official
123 Any Street, Anycity, Anycountry
certifyingofficial@server.com
tel.: 613-555-5555

Certifying Certification
official’s seal MUST include the words
or stamp “true copy of the original”.
in ENGLISH I certify this be a true
OR FRENCH.
L•
CER photocopy to ginal
copy of the ori
T
A

IF
AL SE

document
Y I N G OF

Certifying official’s SIGNATURE.

EG

L FIC
IAL •
DATE of certification.
1, 2013
January
MCC | Certification Sample - Passport