J3 Trainers and Consultants Inc.

D2, 2F, One Beacon Business Center,

Beacon Avenue, PDO Business Park,
Carmen, Cagayan de Oro City, Misamis
Oriental, Philippines, 9000

REQUEST TO RE-ISSUE CERTIFICATE

Name
Last First Middle Suffix (e.g., Jr.)

Mailing Address

Email Phone

Title of the Training Attended Date of the Training Attended

Location/Venue of the Training

REASON FOR REQUEST

Ƒ My previous certificate was damaged. I have attached or enclosed my previous certificate.
Ƒ My previous certificate was lost or destroyed. The circumstances of the loss or destruction are:

Use a separate form for each certificate. Please allow 7 days for processing.
The name on your certificate will match your name in our records.

MAILING INFORMATION
When my certificate is ready:

Ƒ Please notify me and hold it for pickup.

Ƒ Please mail it to me (fee depends on the courier).

FEES & PAYMENT

Certificate reissue fee is Php 350.00 per certificate. Optional mailing fee will vary on the courier.

Ƒ Cash
Ƒ Check

CERTIFICATION
I declare under penalty of perjury that the foregoing information is true and correct.

Signature Date

Ö If you present this form in person at the J3 Office, please bring photo identification and sign in the presence of our staff.

If you mail this form, we require you to notarize it.

For office use only

Received by Date

Date certificate ordered Date certificate mailed or notification sent