Each field marked by an asterisk (
*) must be completed.
The applicant is the individual who requested a certificate and completed the application online.
Applicant Information
Service Level
Type of Certificate Requested
NOTE: You may only apply for one type of certificate refund at a time.
Collection of Personal Information
Personal information contained on this form is collected under the authority of the Vital Statistics Act, R.S.O. 1990, c.V.4, as amended, and will be used to provide certified copies, extracts, certificates, or search notices and to verify the information provided and your entitlement to the service requested and for law enforcement and security purposes. It is an offence to wilfully make a false statement on this form. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General, 189 Red River Road, PO Box 4600, Thunder Bay ON P7B 6L8. Telephone: Outside Toronto 1-800-461-2156 or in Toronto 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax: 807-343-7459.