LCBO Social Responsibility

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THE BYID PHOTO I.D. CARD APPLICATION FORM

SECTION 1 - APPLICANT INFORMATION
Applicant's Full Name:

Permanent Address (number, street, apt. #):		City:

Province:	Postal Code:	Telephone Number:

Date of Birth (month, day, year):		Place of Birth (city, province, country):

Name of Last Secondary School attended:		Last Year Attended:

Name of School Principal:		Telephone Number of School:

I solemnly declare that: (i) the enclosed document showing proof of age was issued to me and that I am the person named therein, (ii) the statements made in this application are true, (iii) the photograph enclosed is a true likeness of me, (iv) I am between the ages of 19 and 35, and (v) I have known my Guarantor personally for at least two years.
Signature of Applicant:		Date:

SECTION 2 - GUARANTOR'S CERTIFICATION I have known the applicant for at least two years, and by signing each document (the application form, the copy of the document showing proof of age, and the photograph to be a true likeness of the applicant), I have certified all information supplied by the applicant in this application to be true. I, the undersigned, am a Canadian citizen, resident in Ontario, over the age of nineteen years, and meet the eligible Guarantor requirements noted on the previous page.
Name of Guarantor:		Occupation of Guarantor:

Business Address:

Telephone Number:		Fax Number:

Signature of Guarantor:		Date: