Disponible en français11331E (2014/12) © Queen's Printer for Ontario, 2014

Payment Form for Change of Sex Designation on a Birth Registration Payment Method and Credit Card Authorization

Office of the Registrar General PO Box 3000 189 Red River Road Thunder Bay ON P7B 5W0

Applicant’s InformationLast Name First Name Middle Initial

Subject’s InformationLast Name First Name Middle Initial

Fees

Application to Change the Sex Designation on a Birth Registration - $37.00

Birth Certificate (Short Form) - $25.00

Certified Copy of Birth Registration (Long Form) - $35.00

• Please ensure the correct fee along with all forms, evidence and all original certificates are returned.

• Please send your request by mail and pay by money order (made payable to Minister of Finance), VISA, MasterCard or American Express.

• If you are sending payment from outside Canada, you must pay with an international money order in Canadian funds drawn on a Canadian clearing house, or by VISA, MasterCard or American Express.

• We do not accept cash as payment for any type of application.

• Please note that fees are subject to change without notice.

Method of Payment (medium sensitivity when completed)

For Money Order, please make payable to “Minister of Finance”

Money Order VISA MasterCard American Express

Credit Card Information

Name of Cardholder (as it appears on the credit card)Last Name First Name Middle Initial

Credit Card Number Expiration Date (mm/yyyy)

Signature Date (yyyy/mm/dd)

For assistance, please visit ServiceOntario.ca or contact us at: • Toll-free: 1-800-461-2156 • Toronto: 416-325-8305 • TTY Toll-free: 1-800-268-7095 • TTY Toronto: 416-325-3408