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St name 7. Profession or relationship to applicant 10. Middle name(s) 12. Secondary phone number Please list which two identification documents the applicant showed you (see Page 15) for a list of examples. Government issued photo identification (name, age, photo, signature and date of birth) Eligibility to work in Canada I confirm that the names match on both identification documents and that these are the documents that the applicant will be using in the licence application. By signing this.

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