Application For New Licence As A Funeral Director Embalmers

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					          Application For New Licence As A Funeral Director
             Embalmers And Funeral Directors Act, 1975

Applicant
Name                                                City/Town
Street                                              Postal Code

P. O. Box                                           Telephone

The Following Items Are Enclosed (please check all items that are enclosed)
           Birth Certificate (proving age 19 or over)

           High School Graduation Certificate

           Two References Of Good Moral Character (not relative) (indicating experience in the
           funeral industry)
           Funeral Services Certificate from recognized college

           Necessary affidavits of apprenticeship, etc.

           $125.00 Fee

Place Of Business Or Employer
Name                                                City/Town

Street                                              Postal Code

P.O. Box                                            Telephone                 Fax

Signature Block
Date

Applicant (please print)

Applicant’s Signature

Please Return This Application To:

The Embalmers and Funeral Directors Board
P. O. Box 839
Lewisporte, NL
AOG 3AO