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CERTIFIED IDENTITY CONFIRMATION Candidate Current legal name given name s and surname Date of birth 19 / / yy / mm dd I certify that on the date set forth below the individual named on this form did appear personally before me and that I did identify this individual by a comparing his/her physical appearance with the photograph on the valid government-issued identifying Candidate photo and b comparing the individual s signatures made in my presence on this form with the signature on his/her valid government-issued identifying document s. The statements in this document are subscribed and sworn before me by the individual on this day in the month of in the year 20. Firmly attach one photograph here. See below for photograph In my capacity as At Name Signature Telephone Email ENGLISH OR FRENCH. Candidate s signature NOTE Candidate Please attach a second identical photograph which will be scanned as applicable. MCC Candidate Code if available Photograph Requirements DO NOT CERTIFY Attach ....

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The Physician Credentials Registry of Canada (PCRC) is a division of the Medical Council of Canada (MCC). PCRC performs two vital licensing functions: it source verifies physician credentials and it serves as a centralized electronic repository of a physician's source-verified core medical credentials.

What is an identity verification form? An identity verification form is a document or online questionnaire that collects personal information from an individual, such as their name, date of birth, photo, driver's license, electronic signature, and social security number.

Should be passport-size, approximately 50 mm (2 inches) wide by 70 mm (2 3/4 inches) long. Must be passport-quality, i.e., full-face and very clear with contrasting background. Scanned photographs are not passport-quality and therefore not acceptable. Must be an original, i.e., not taken from an existing photo.

When scheduling an MCC exam, your identity documents are reviewed and accepted by the MCC. These documents remain valid on your physiciansapply.ca account for a period of 5 years, which is your Identity Validity Period.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232