500 Old St. Patrick St, Unit D
Ottawa, Ontario K1N 9G4
Toll Free: 800-263-4889
REQUEST FOR REPLACEMENT (MNO) CARD
Please print clearly and send by land mail (not fax) to the Registry branch at the above address.
*You should send a recent photo if your previous card was issued more than three years ago.
I hereby request a replacement citizenship card from the Métis Nation of Ontario.
My Citizen number is: ________________ Need replacement Harvest Card _ Yes _No
Full Name: _____________________________________ Date of Birth: ___________________
(PLEASE PRINT CLEARLY) (MONTH / DAY / YEAR)
Reason for Change: Please check all that apply.
_ Moved _ Card lost _ Card stolen
_ Photo update (New photo must be clear) _ Wrong information on card
_ Name changed from ___________________________ to ________________________________
New Contact Information: P.O. Box or RR Number: _______ Apartment or Unit Number: _______
Street Address: ____________________________________________________________________
City/Town: ____________________________________Province: ON (Ontario Residents Only)
Postal Code: __________________ Phone Number: ____________________________________
Please provide your e-mail address to receive periodic announcements via email from MNO.
E-mail address: _________________________________________________
Declaration: Please accept this as my written confirmation that I solely support the Métis Nation of
Ontario. I have no affiliation or membership card with another Métis or First Nation organization.
Please sign in the
This is to certify that the Bearer of this Card is “Citizen’s signature”
recognized as a Métis within the meaning of the section ONLY
Registry Process of the Métis Nation of Ontario. (blue ink)
The Registrar and Date of Issue
Registrar sections are reserved for MNO
Date of Issue