Application Forms
Application Instructions for Replacement of Lost/Stolen Service Medals ONLY to Retired CF Members and Civilians
This site is to be used only by retired members of the Canadian Forces (CF) or civilians (Canadian citizens) to apply for Service Medals administered by the Department of National Defence, Directorate - Honours and Recognition (DH&R).
SERVING members of the Canadian Forces wishing more information (ie: eligibility, policies, directives, etc) are to consult DH&R's DIN site prior to submitting any inquiries through their Chain of Command.
- Requests for information from a military service file or for a statement of military service should be addressed to Library and Archives Canada at 1-866-578-7777.
- Requests for commission scrolls, CF service pins and identification cards (CF 75) should be addressed to the Director Military Careers Administration and Resource Management (DMCARM) at (613) 945-0274 or (613) 992-1228.
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For REPLACEMENTS of:
- Order of Military Merit;
- Military Valour Decorations (Victoria Cross, Star of Military Valour, Medal of Military Valour);
- Canadian Bravery Decorations (Cross of Valour, Star of Courage, and Medal of Bravery);
- Meritorious Service Decorations;
- Mention-in-Dispatches;
- Canadian Volunteer Service Medal for Korea (CVSM - Korea);
- Queen's Medal for Champion Shot;
- COMMEMORATIVE MEDALS (i.e., Silver Jubilee, Canada 125, Golden Jubilee, etc);
the Chancellery, Government House, at 1-800-465-6890, is the responsible agency.
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For REPLACEMENTS of:
- Second World War Medals;
- Medals for the Korean Conflict (except for the CVSM for Korea);
Veterans Affairs Canada, at 1-866-522-2122, is the responsible agency.
- For INITIAL ISSUE ONLY to retired members of the Canadian Forces (CF) or civilians.
For the REPLACEMENT of lost/stolen medals (retired members of the Canadian Forces (CF) or civilians) of the following service medals administered by the Department of National Defence:
- Gulf and Kuwait Medal;
- Somalia Medal;
- South-West Asia Service Medal;
- General Campaign Star (All Bars);
- General Service Medal including eligible Civilians (All Bars);
- Special Service Medal all bars;
- Canadian Peacekeeping Service Medal;
- United Nation Medals;
- NATO Medals;
- ICSC (Indochina);
- MFO (Sinai);
- ECMM (Yugoslavia);
- INTERFET (East Timor);
- LSGC Medals (Navy, Army, RCAF);
- Efficiency Decoration, Medal and/or Clasp;
- Canadian Forces' Decoration and all Clasps;
- Memorial Cross;
- Chief of the Defence Staff Commendation; and
- RCAF Operational Tour Wings.
Application for Replacement Only of Honours and Awards for Retired Members of the Canadian Forces
The following document is available for downloading or viewing:
For more information on accessing this file, please visit our help page.
PROTECTED A (When completed)
Instructions
This application form may only be used by retired members of the Canadian Forces or their next of kin to apply for the replacement of those medals (as listed below) which are administered by the Department of National Defence, Directorate of Honours and Recognition (DH&R). Additional information can be found on our Internet web site under Directorate of Honours and Recognition.
Serving members of the Canadian Forces shall not use this form (their unit shall apply on-line (DIN) on their behalf in accordance with procedures detailed in CANFORGEN 106/00).
To obtain replacement of Canadian orders and decorations, the Canadian Volunteer Service Medal (CVSM) for Korea and/or commemorative medals, contact the Chancellery of Honours at Rideau Hall at 1-800-465-6890 or write to:
Chancellery of Honours
Rideau Hall
1 Sussex Drive
Ottawa ON K1A 0A1
To obtain replacement of Second World War medals as well as those related to the Korean conflict (with the exception of the Canadian Volunteer Service Medal for Korea), contact Veterans Affairs Canada at 1-877-522-2122 or write to:
Honours and Awards
Veterans Affairs Canada
66 Slater Street, Suite 1411
Ottawa ON K1A 0P4
To obtain replacement for pre-1972 British gallantry decorations, contact the UK Ministry of Defence Medal Office at 011 44 14 1224 3600 or write to:
Ministry of Defence Medal Office
Building 250
RAF Innsworth
Gloucester G3L 1HW
United Kingdom
To obtain information from a military service file or a statement of military service, contact Library and Archives Canada at 1-866-578-7777 or write to:
Library and Archives Canada
Personnel Record Unit (PRU)
395 Wellington Street
Ottawa ON K1A 0N3
To obtain CF service pins and identification cards (CF 75), contact the Director Military Careers Administration (toll free) at 1-866-240-6726, or write to:
Director Military Careers Administration 4-2
National Defence Headquarters
MGen George R. Pearkes Building
101 Colonel By Drive
Ottawa ON K1A 0K2
To obtain replacement of medals administered by the Department of National Defence (listed below), complete and sign this form and forward it to the Directorate of Honours and Recognition BY MAIL ONLY along with the appropriate replacement fees. To speed up the review of your application, you are requested to provide a copy of documentary proof of service.
Section 1 – Applicant type (Select one)
Military (Retired CF) _____ Complete Sections 1abc, 2, 3 and 5
Next of kin (NOK) of Military _____ Complete Sections 1a, 1c, 2, 3, 4 and 5
Decesed date (dd/mm/yy) _____
Section 1a – Military (Retired CF) applicant information (All information MUST be completed. Ensure correct spelling of names, including accents, spaces between letters, lower case letters, etc.)
Last name _____ First Name _____ Middle initial(s) _____
Date of birth (dd/mm/yyyy) _____
Section 1b – Military (Retired CF) applicant contact information (Leave blank if next of kin)
Address _____
City _____ Province _____ Country _____ Postal code _____
Telephone _____ Alternate telephone _____ Email (optional) _____
Section 1c – Military service information (All information MUST be completed)
Service (Regimental) number _____
Note: Do not insert Social Insurance Number (SIN). The collection of the SIN is not authorized under the Canada Pension Plan (CPP) Act. INSERT only alpha-numeric Service number. If you are not in possession of either a Regimental number (pre-1967) or a current CF Service number (X11 111 111) LEAVE THIS FIELD BLANK. The Department of National Defence will contact you if further information is required in order to ascertain eligibility.
Enrolment date (dd/mm/yyyy) _____ Release date (dd/mm/yyyy) _____
Rank upon retirement _____
Rank at time of eligibility (for awards that are engraved) _____
Environment (Navy, Army or Air Force) _____
Name at time of service (if legally changed after release) _____
Section 2 – Medal selection information
Please check the box(es) related to the medal(s) for which you need replacements. The fees include engraving where appropriate, as well as administrative charges and shipping costs.
All fees are in Canadian Dollars and payment shall be made by Money Order or Bank Draft payable to the Receiver General of Canada. No cash or personal cheques will be accepted.
If the applicant does not forward the appropriate fees with the application, and is contacted by DH&R, the application will only be held for 60 days pending receipt of payment, after which period, the file will be closed if no payment has been made.
| Medal | Cost | Comments (Write on reverse if required) |
|
|---|---|---|---|
| _____ Canadian Forces' Decoration (CD) | $40.00 | ||
| _____ Canadian Forces' Decoration (CD) Clasp | $15.00 each | ||
| _____ Canadian Peacekeeping Service Medal | $25.00 | ||
| _____ Chief of Defence Staff Commendation | No fee | ||
| _____ European Community Monitor Mission (ECMM) | $25.00 | ||
| _____ Efficiency Decoration (ED) | $225.00 | ||
| _____ Efficiency Medal | $105.00 | ||
| _____ Efficiency Medal Clasp | $18.00 | ||
| _____ General Campaign Star - Allied Force | $55.00 | ||
| _____ General Campaign Star - South-West Asia | $55.00 | ||
| _____ General Campaign Star - Expedition | $55.00 | ||
| _____ General Campaign Star - Rotation Bar | $15.00 | ||
| _____ General Service Medal - Allied Force | $70.00 | ||
| _____ General Service Medal - South-West Asia | $70.00 | ||
| _____ General Service Medal - Expedition | $70.00 | ||
| _____ General Service Medal - Rotation Bar | $15.00 | ||
| _____ Gulf and Kuwait Medal (no bar) | $25.00 | ||
| _____ Gulf and Kuwait Medal (bar only) | $2.00 | ||
| _____ International Commission for Supervision and Control (ICSC) (Indochina) | $45.00 | ||
| _____ INTERFET (East Timor) | $25.00 | ||
| _____ Long Service and Good Conduct Medal - Army | $125.00 | ||
| _____ Long Service and Good Conduct Medal - Navy | $125.00 | ||
| _____ Long Service and Good Conduct Medal - RCAF | $125.00 | ||
| _____ Memorial Cross | TBD | ||
| _____ Multinational Force and Observers (MFO) (Sinai) | $25.00 | ||
| _____ NATO Medals - Specify Mission(s) | $10.00 each | ||
| _____ Operational Service Medal - South-West Asia | $50.00 | ||
| _____ Operational Service Medal - Sierra Leone | $50.00 | ||
| _____ Operational Service Medal - Haiti | $50.00 | ||
| _____ Operational Service Medal - Sudan | $50.00 | ||
| _____ Operational Service Medal - Humanitas | $50.00 | ||
| _____ Operational Service Medal - Expedition | $50.00 | ||
| _____ Operational Service Medal Rotation Bar | $15.00 | ||
| _____ RCAF Operational Tour Wings | No fee | ||
| _____ Sacrifice Medal | $90.00 | ||
| _____ Sacrifice Medal (bar only) | $20.00 | ||
| _____ Somalia Medal | $25.00 | ||
| _____ South-West Asia Service Medal | $25.00 | ||
| _____ South-West Asia Service Medal Rotation Bar | $2.00 | ||
| _____ Special Service Medal with bar(s) _____ Alert bar _____ Humanitas bar _____ NATO bar _____ Peace bar _____ NATO bar |
$40.00 | ||
| _____ United Nation Medals Specify Mission(s): | $10.00 each | ||
Section 3 – Next of kin information (All information MUST be completed)
If you are submitting the application on behalf of someone else, complete this section. (Ensure correct spelling of names, including accents, spaces between letters, lower case letters, etc.)
Title (if applicable) _____ Last name _____ First name _____ Middle initials(s) _____
Relationship to potential recipent _____
Address _____
City _____ Province _____ Country _____ Postal code _____
Telephone ____ Alternate telephone_____ Email (optional) _____
Section 4 – Declaration
The following STATUTORY DECLARATION must be completed in the presence of a Commissioner of Oath or, in most provinces, any commissioned Regular Force Officer, city official, physician, postmaster or any professional vested with the right of receiving an Oath, giving full particulars of the loss and actions taken to receive the medals(s).
I do solemnly declare that this application is being made for medals I have been awarded but have since been lost, stolen or in any other way destroyed for the following reasons: _____
Declared before me at the city (Town, etc.) of _____
In the County (District, etc.) of _____ in the Province of ______
This (date) _____ day of (month) _____ 201____.
Name of Declarant (please print) _____ Signature of Declarant _____
Name of Witness (please print) _____ Signature of Witness _____
Submission
Please keep a copy for your records. Return original completed form along with your payment and copies of any supporting documentation to:
Directorate of Honours and Recognition
Building 347, Uplands Site
National Defence Headquarters
101 Colonel By Drive
Ottawa ON K1A 0K2
To protect your privacy and security DO NOT FAX OR EMAIL any application forms or supporting documentation.
Applications are normally processed within 90 days of receipt. For assistance in completing this form or for clarification on eligibility, call 1-877-741-8332 (toll free). Listen carefully to the entire options menu before making your selection.
For assistance in completing this form or for clarification on eligibility, call, 1-877-741-8332 (Toll free). Listen carefully to the entire options menu before making your selection.
PROTECTED A (When completed)
