Licence Renewal for Handler of a Regulated Substance

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c. F-15.0.1 as it relates directly to and is necessary for the processing of the renewal application. If you have any questions about this collection of personal information, you may contact the Chief Boiler Inspector at 31 Gordon Drive, Charlottetown, PE, C1A 7N8 or by telephone at: 902-368-5567.

Identification

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Handler Registration Number

Heating, Refrigeration, Air Conditioning Institute (HRAI) Certificate Number

Business Name

Are you filling this form out on behalf of someone else?

Contact Information

First Name

Last Name

Telephone Number

For example: 902-555-5555