Suite 1100 – 66 Slater Street, Ottawa, ON K1P 5H1
Tel: 613-798-1006 | Toll-Free: 855-798-1006 | Fax: 613-722-4225
E-mail: info@mnoregistry.ca
Web: metisnation.org
REPLACEMENT MNO CARD REQUEST
My Citizen Card number:
Name:
Date of Birth:
Reason for change:
Moved Card Lost Card Stolen Wrong Information on Card
Name change* from to
* Proof of name change required: copy of marriage certicate or provincial government certicate of name change
Contact information (MUST be completed):
Street Address:
Apartment or Unit #
RR # PO Box:
City / Town: Province: Postal Code:
Home Phone number:
Mobile Phone number:
Email:
Declaration:
Please accept this as my written conrmation that I solely support the Métis Nation of Ontario. I have no afliation or membership card
with any other Métis or First Nation organization.
Last First MM / DD / YYYY
PLEASE PRINT CLEARLY AND SEND FORM TO INFO@MNOREGISTRY.CA OR TO REGISTRY OFFICE ADDRESS FOUND BELOW.
*** Updated photos are required if your previous card was issued more than 3 years ago. ***
MÉTIS NATION OF ONTARIO
Signature: Date:
MM / DD / YYYY
click to sign
signature
click to edit