Designate Acknowledgement for Commercial Bait Harvesting | Ministry of Natural Resources and Forestry

Instructions
Personal information contained on this form is collected under the authority of the Fish and Wildlife Conservation Act, 1997 and will be used for the purpose of licensing and identification. Please direct further enquiries to the District Manager of the MNRF issuing district.

Complete form for each person designated on the licence and return to the issuing office. Designated persons will not be named on the licence until this form has been completed and returned.

Fields marked with an asterisk (*) are mandatory.

Licence information

Licence Number*

Issue Date (yyyy/mm/dd)*

Expiry Date (yyyy/mm/dd)*

Designate acknowledgement

I, being the designate to be listed on the licence named above, agree to abide by the Terms and Conditions.

Last Name*

First Name*

Middle Name

Date of Birth (yyyy/mm/dd)*

Primary Telephone*

Ext.

Secondary Telephone

Ext.

Fax Number

Email Address

Street Number

Street Name

PO Box

RR#

Lot

Concession

General Delivery

City/Town/Municipality*

Province/State*

Postal Code/Zip Code*

Signature of Designate

Date Signed (yyyy/mm/dd)

Authorized Bait Harvest Areas* Required

Licensee information

I (we), the licensee(s) listed below, holder(s) of Commercial Bait Harvest Licence listed above do hereby appoint the named designate to conduct on my/our behalf commercial bait harvesting under the authority of my/our commercial bait harvesting licence and I (we) certify that the information provided on this form is true.

I (we) certify that the information provided in this application is true.

Signature of Licensee

Date Signed (yyyy/mm/dd)

Licence Issuer

Last Name*

First Name*

Date Received (yyyy/mm/dd)*

Issuing MNRF District*

Issuing MNRF Area*