Request for approval of an award of a Commonwealth and/ or Foreign Order, Decoration or Medal to a Canadian Citizen

PDF Version (83 KB)Footnote *

Donor Country:

Proposed order, decoration or medal:

Name and address in Canada of proposed recipient:

Place of birth:

Date of Canadian citizenship (if born outside Canada):

Criterion under which it is proposed to make the award (indicate by placing an X in appropriate box):

(a) an extraordinary  service to mankind;

(b) conspicuous bravery in saving or attempting to save life;

(c) an exceptional service rendered to the country desiring to make the award;

(d) any substantial act or acts contributing to better relations between Canada and the country desiring to make the award.

Description of meritorious act(s) and/or achievement(s) for which the award will be made (use additional page(s) if necessary):

Footnotes

Footnote *

If you require a plug-in or a third-party software to view this file, please visit the alternative formats section of our help page.

Return to footnote * referrer