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  • Replacement Certificates Online Payment Form

    Please read the instructions below carefully prior to completing the accompanying form.

  • INSTRUCTIONS

    Please ensure to send inquiries and requests to the appropriate point of contact before you proceed to complete this form. The point person will first confirm the trainee was in fact registered with the Department of Medicine, University of Toronto, and will then provide the appropriate information on how to obtain the training certificate(s):

    • Request for Residency Replacement Certificate(s) – Residency Coordinator at medicine.training@utoronto.ca
    • Request for Fellowship Replacement Certificate(s) – Fellowship Coordinator at fellowships.medicine@utoronto.ca

    This online payment form is to be used by physicians (residents, and clinical and research fellows) whose training ended before June 30, 2011, who wish to have replacement certificate issued (lost, destroyed, or damaged the original certificate, and/or if there was a name change).

     Important Notes:

    • Processing Time: Upon receipt of all the necessary information and payment, the request will be finalized within 20-25 business days
    • Refund Policy: In the event we are unable to fulfill the request, the full refund will be issued as a cheque that will be mailed out, which may take up to 6-8 weeks. Otherwise, all payments are final and no refund will be issued.

    For detailed information, please refer to the Department of Medicine Certificate Process.

  • Statement of Obligation

  • In accordance with the University of Toronto’s Department of Medicine policy, Certification of Training will not be released for trainees/alumni with outstanding administrative requirements and/or financial obligations of the training program and Postgraduate Medical Education (PGME) to the University. Requests will not be processed until the administrative and/or financial hold is cleared and removed from the record.

  • Personal Information

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  • Replacement Certificate Request(s)

    You may request up to three (3) replacement certificates. Replacement certificate(s) will be issued in the circumstances outlined below. Please select the option(s) below that applies to you and read the specific instructions carefully.

  • Replacement Certificate Request #1

  • Original certificate lost or destroyed

    Instruction:

    In the case of a lost or destroyed certificate, you must complete the DOM Certificate Declaration Form (PDF) and have it signed and sealed by a Notary Public, legally swearing that the original certificate has been lost or destroyed. Your original signature must appear on the DOM Certificate Declaration Form. Process for the replacement certificate will begin upon receipt of the completed DOM Certificate Declaration Form and payment.

  • Original certificate damaged

    Instruction:

    You must return your damaged original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of the original certificate and payment.

  • Original certificate never claimed

    Instructions:

    • You must verify via email with the appropriate personnel (Residency or Fellowship Coordinator) that your certificate was never claimed. Once the request is verified that your certificate was never claimed, you may continue to proceed with filling out this Certificates Online Payment Form.
    • Please note that Department of Medicine will hold certificates for two (2)  calendar years from the date of your training completion date. Certificates not claimed after two (2) calendar years are destroyed for reasons of security and storage.

  • Original certificate requires a name change

    Instructions:

    • In order to obtain a Replacement Certificate printed with a different name, you must first have your name officially changed in the University of Toronto PGME record. Please refer to PGME Certificate Procedures for steps on how to proceed with this request.
    • Once your name is officially changed in the University of Toronto PGME record, you can then request for a Replacement Certificate. You must return your original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of either the original certificate or DOM Certificate Declaration Form (PDF) and payment.
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  • Replacement Certificate Request #2

  • Original certificate lost or destroyed

    Instruction:

    In the case of a lost or destroyed certificate, you must complete the DOM Certificate Declaration Form (PDF) and have it signed and sealed by a Notary Public, legally swearing that the original certificate has been lost or destroyed. Your original signature must appear on the DOM Certificate Declaration Form. Process for the replacement certificate will begin upon receipt of the completed DOM Certificate Declaration Form and payment.

  • Original certificate damaged

    Instruction:

    You must return your damaged original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of the original certificate and payment.

  • Original certificate never claimed

    Instructions:

    • You must verify via email with the appropriate personnel (Residency or Fellowship Coordinator) that your certificate was never claimed. Once the request is verified that your certificate was never claimed, you may continue to proceed with filling out this Certificates Online Payment Form.
    • Please note that Department of Medicine will hold certificates for two (2) calendar years from the date of your training completion date. Certificates not claimed after two (2) calendar years are destroyed for reasons of security and storage.

  • Original certificate requires a name change

    Instructions:

    • In order to obtain a Replacement Certificate printed with a different name, you must first have your name officially changed in the University of Toronto PGME record. Please refer to PGME Certificate Procedures for steps on how to proceed with this request.
    • Once your name is officially changed in the University of Toronto PGME record, you can then request for a Replacement Certificate. You must return your original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of either the original certificate or DOM Certificate Declaration Form (PDF) and payment.
  • Browse Files
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  • Browse Files
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  • Replacement Certificate Request #3

  • Original certificate lost or destroyed

    Instruction:

    In the case of a lost or destroyed certificate, you must complete the DOM Certificate Declaration Form (PDF) and have it signed and sealed by a Notary Public, legally swearing that the original certificate has been lost or destroyed. Your original signature must appear on the DOM Certificate Declaration Form. Process for the replacement certificate will begin upon receipt of the completed DOM Certificate Declaration Form and payment.

  • Original certificate damaged

    Instruction:

    You must return your damaged original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of the original certificate and payment.

  • Original certificate never claimed

    Instructions:

    • You must verify via email with the appropriate personnel (Residency or Fellowship Coordinator) that your certificate was never claimed. Once the request is verified that your certificate was never claimed, you may continue to proceed with filling out this Certificates Online Payment Form.
    • Please note that Department of Medicine will hold certificates for two (2) calendar years from the date of your training completion date. Certificates not claimed after two (2) calendar years are destroyed for reasons of security and storage.

  • Original certificate requires a name change

    Instructions:

    • In order to obtain a Replacement Certificate printed with a different name, you must first have your name officially changed in the University of Toronto PGME record. Please refer to PGME Certificate Procedures for steps on how to proceed with this request.
    • Once your name is officially changed in the University of Toronto PGME record, you can then request for a Replacement Certificate. You must return your original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of either the original certificate or DOM Certificate Declaration Form (PDF) and payment.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Replacement Certificate Request #4

  • Original certificate lost or destroyed

    Instruction:

    In the case of a lost or destroyed certificate, you must complete the DOM Certificate Declaration Form (PDF) and have it signed and sealed by a Notary Public, legally swearing that the original certificate has been lost or destroyed. Your original signature must appear on the DOM Certificate Declaration Form. Process for the replacement certificate will begin upon receipt of the completed DOM Certificate Declaration Form and payment.

  • Original certificate damaged

    Instruction:

    You must return your damaged original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of the original certificate and payment.

  • Original certificate never claimed

    Instructions:

    • You must verify via email with the appropriate personnel (Residency or Fellowship Coordinator) that your certificate was never claimed. Once the request is verified that your certificate was never claimed, you may continue to proceed with filling out this Certificates Online Payment Form.
    • Please note that Department of Medicine will hold certificates for two (2) calendar years from the date of your training completion date. Certificates not claimed after two (2) calendar years are destroyed for reasons of security and storage.

  • Original certificate requires a name change

    Instructions:

    • In order to obtain a Replacement Certificate printed with a different name, you must first have your name officially changed in the University of Toronto PGME record. Please refer to PGME Certificate Procedures for steps on how to proceed with this request.
    • Once your name is officially changed in the University of Toronto PGME record, you can then request for a Replacement Certificate. You must return your original certificate to us along with your request. Please note that faxed or electronic copies will not be accepted. Process for the replacement certificate will begin upon receipt of either the original certificate or DOM Certificate Declaration Form (PDF) and payment.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
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    Choose a file
    Cancelof

  • Delivery Options

    If you are requesting a replacement certificate for more than one type of training, please consider providing information for all of them in this one (1) single request form for the purpose of shipping consolidation (ie. to avoid additional delivery costs).

  • Shipping Mailing Address Information

    Please note that there is a cost associated with delivering all other certificates. This will be an additional cost on top of certificate production.

  • Online Payment Information

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  • The Department of Medicine has partnered with Moneris (service provider) to provide clients with an online credit card fee payment option.

    The online Mastercard and Visa Canadian Dollar verification fee payment service is inclusive of a convenience fee collected directly by Moneris.

  • Acknowledgement

  • By signing below, I declare that the information I have given in this form is accurate and true, and I acknowledge that my payment and order is final.

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  • Freedom of Information and Protection of Privacy: The University of Toronto is committed to the protection of privacy. Ontario universities are covered by the Freedom of Information and Protection of Privacy Act (the Act) which supports access to University records and protection of privacy. The University upholds these principles. For detailed information and its application, please visit https://www.utoronto.ca/privacy.

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