Certificate Request

To request a certificate from MP Bernard Genereux to mark a special milestone, please complete the form below.

Your information:

Your First Name*

Your Last Name*

E-mail*

Mailing Address*

Apartment

City*

Postal Code*

Mobile*

Occasion* Wedding AnniversaryBirthdayVolunteerOther Celebration

Date of Occasion*

Certificate Recipient

First Name*

Last Name*

Second Recipient (for Wedding & Anniversary Certificates)

First Name

Last Name

Please provide any any additional details here:

Please select how you would like to receive your certificate:

By mailPick it up from our Montmagny OfficePick it up from our Rivière-du-Loup Office

I have verified the above information is accurate, and I understand that any incorrect information may delay the process of my certificate request