Simcoe-Grey MP Community Leader Awards - Apply here before the March 31, 2023 deadline!

Certificate Request Form

We offer congratulatory certificates for residents celebrating a significant anniversary, birthday or other special occasion. For certain milestones, you may also request certificates from the Prime Minister’s office and the Governor General.

Certificate requestor's information

First Name*

Last Name*

E-mail*

Mailing Address*

Apartment (optional)

City*

Postal Code*

Mobile (optional)

Certificate recipient's information

First Name*

Last Name*

E-mail*

Mailing Address*

Apartment (optional)

City*

Postal Code*

Mobile (optional)

Type of Celebration*

AnniversaryBirthdayOther Special Occasion (Please specify below)

If you selected Other, please provide details.

Date to appear on certificate:*

Name(s) as it/they should appear on certificate:

Name(s)*

Special instructions or requests:

Special instructions