Form - Request for approval of an award of a Commonwealth and/or foreign order, decoration or medal to a Canadian citizen

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Instructions:

• Please complete this form by marking an “x” in the appropriate box or by making filling out any required section.
• Please send your completed form via email to foreignhonours-distinctionsetrangeres@international.gc.ca.
• If you have any questions or require any assistance in completing this form, please send an email to foreignhonours-distinctionsetrangeres@international.gc.ca.

1. Reason for the awarding of this honour (please select the appropriate option)

• An extraordinary service to mankind
• Conspicuous bravery in saving or attempting to save life
• An exceptional service rendered to the country desiring to make the award
• Any act improving relations between Canada and the awarding country

2. Please indicate the Donor Country:

3. Please indicate the Honour(s) official name(s):

4. Is this honour conferred by a Head of State? Canada only evaluates honours conferred by a Head of State.

• Yes
• No
• Not Applicable (NATO-UN)

5. Please provide the recipient current contact information. It will be used for correspondence:

• Current title or rank:
• Name commonly used:
• Current post-nominals:
• Street address:
• City, province/territory, postal code:
• Email address(es):

6. Does the recipient hold dual citizenship? If yes, please specify which other country.

7. Please describe what meritorious act(s) and/or achievement(s) the recipient performed to receive this award, attach further pages if necessary: