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APPLICATION FOR AN ANGLING LICENCE FEE …

APPLICATION FOR AN ANGLING LICENCE FEE REDUCTION (DISABLED B.C. RESIDENTS ONLY) This application is to be completed by any B.C. Resident with a severe and permanent physical or mental

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Text of APPLICATION FOR AN ANGLING LICENCE FEE …

APPLICATION FOR AN ANGLING LICENCE FEE REDUCTION (DISABLED RESIDENTS ONLY) This application is to be completed by any Resident with a severe and permanent physical or mental disability who wishes to obtain an annual Non-Tidal Angling Licence for a reduced fee. Note: Non-tidal Angling licences are not required for anglers under 16 years of age. Application Instructions Please read each part of the application carefully and ensure all required information is provided. Please note that if you can provide documentation for any ONE program listed in PART B, you DO NOT have to complete PART C. Be sure to sign and date the Declaration Statement in PART D. Completed applications should be presented to a Service BC office. To locate a Service BC office, refer to the website at . Alternatively, applications can be mailed to the Fish, Wildlife & Habitat Management Branch, Ministry of Forests, Lands, and Natural Resource Operations, PO Box 9363 Stn Prov Govt, Victoria BC V8W 9M2. Do not send cash or cheques in the mail. PART A: APPLICANT S INFORMATION To be completed by applicant or guardian (if guardian please indicate) Surname ________________________________ First Name ________________________ Initial _______ Address ________________________________________ _______ City ___________________________ Postal Code ___________ Telephone No. _________________ Date of Birth ______/________/_______ Year Month Day Email: PART B: PERSONAL PROOF OF DISABILITY - To be completed by applicant or guardian Check any ONE of the applicable boxes and produce the document indicated in parentheses. Note: If you are submitting your application by mail, attach a photocopy of the supporting documentation. I have been approved for and currently benefit from one of the following programs due to my disability: Persons with Disabilities (PWD) designation under the Employment and Assistance for Persons with Disabilities Act, provincial Ministry of Employment and Income Assistance (produce written confirmation from the Ministry indicating that you have been approved for and are currently receiving this benefit.) NOTE: Cheque stubs are NOT acceptable documentation. Home Owner Grant (produce a completed copy of FORM B Certificate of Physician & Property Owner.) Fuel Tax Refund Program for Persons with Disabilities (produce your letter of qualification from the Ministry of Small Business and Revenue or your Application for Registration form completed by your physician.) Handicapped Driver Discount (produce a photocopy of your Owner s Certificate of Insurance and Vehicle Licence, including the Coverages Fees and Premiums portion from ICBC.) Ferries Disabled Status (produce a copy of your Ferries Disabled Status Identification Card.) Parking Permit Program for People with Disabilities - SPARC of BC or Disability Resource Centre (produce a photocopy of your completed parking permit application form, signed by a doctor certifying that you have a permanent disability.) I am registered with an institution for the sight, speech or hearing impaired (produce a photocopy of official documentation verifying that you have a permanent disability.) Canada Pension Plan DISABILITY (produce official documentation verifying that you have been approved for and are currently receiving this benefit). If ONE of the above documents is provided, DO NOT COMPLETE PART C. PART C: MEDICAL USE ONLY To be completed by a practicing registered physician or practicing registered nurse. This service is not covered by the Medical Services Plan. Any charge for this service is the applicant s responsibility. I have access to this applicant s medical records and hereby certify that ___________________________ Name of Applicant has a severe disability that will continue indefinitely without fundamental or marked improvement AND, as a result, the disability impedes this person s normal daily activities ( , preparation, serving and eating of meals; mobility; managing personal affairs; etc.) Date ________/________/________ _______________________ Year Month Day BC Physician MSC No. BC Nurse Registration No. ________________________________________ ____ _______________________________________ Please Print Name Signature of Physician or Nurse ________________________________________ _____________________ ______________________ Name and Address of Medical Office or Facility Telephone No. PART D: DECLARATION STATEMENT THIS SECTION MUST BE COMPLETED To be completed and signed by applicant or guardian (if guardian please indicate) I, _________________________________, do solemnly declare that my disability is severe, permanent and impedes my daily activities ( , assistance required in preparation of meals; mobility, and managing personal affairs; etc). I also solemnly declare that the information provided is true, and I understand that it is an offence under the Wildlife Act to make a false statement. SIGNATURE ________________________________________ _ DATE _________________________ Revised Feb 2013 PART E: FOR GOVERNMENT USE ONLY Prior to issuing an angling licence, please check the following: PART A: Applicant s information is complete. PART B: Appropriate disability documentation was produced, OR PART C: A Physician or Nurse has completed the required information PART D: The applicant/guardian has signed and dated the Declaration Statement. I HAVE 1) APPROVED THIS APPLICATION Angler number: 2) ISSUED AN ANGLIING LICENCE PRINT NAME ____________________________ SIGNATURE __________________________________ TELEPHONE NO. ___________________ LOCATION __________________ DATE _______________

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