Criminal Offence Declaration (Brussels Minor Ball)

Criminal Offence Declaration

The following declaration needs to be completed annually for the two years between your police record checks.

Full Name^*

Date of Birth^*

Criminal Offence Declaration^*

I have no convictions under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada).
I have the following criminal offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.

List of Offences

I agree the above statements to be true, correct and complete^*

YesNo

Criminal Offence Declaration (Brussels Minor Ball)

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