Get Declaration And Request For Replacement License - Dental Board Of ...

This guide will assist you in filling out the Declaration And Request For Replacement License form for the Dental Board of California. Designed for ease of use, this guide provides step-by-step instructions to ensure your form is completed accurately and efficiently.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to access the Declaration And Request For Replacement License form and open it for editing.
2. Indicate the reason for your request by selecting one of the options provided: Lost, Stolen, Destroyed, Original not received, or Other.
3. Fill in your full name in the designated field, including your first name, middle name, and last name.
4. Enter your full address, ensuring to include your street address, city, state, and zip code.
5. Input your license number in the appropriate section.
6. Provide the date your original license was issued, formatted as Month, Day, Year.
7. If applicable, enter the name under which your license was issued, in the case that it differs from your current name.
8. Include your Social Security number, which is required for processing.
9. Enter your telephone number for contact purposes.
10. In the field provided, describe the circumstances leading to your request for a replacement license.
11. Read the certification statement, sign to affirm that all provided information is accurate, and include the date of signing.
12. After completing the form, save your changes. You have the option to download a copy of the completed form, print it for your records, or share it as needed.

Start completing your Declaration And Request For Replacement License form online today.