Applicant
Full Legal Name: _________________________________
Present
Street or Box #: _______________________
City/Town: _____________________
Province: ____________ Postal Code: ________
Telephone No.: (___) ____________ Email Address: _____________________
Date of
Birth: __________________ Place of Birth: _________________
S.I.N.
#.:____________________Occupation: _________________________
Surname at birth: ______________Marriage date: ___________Name of Spouse: ______________________
Name of person
my Mi'kmaq ancestry comes from:
___________________ Please fill out and attach pedigree and/or genealogy
report.
__I am
transferring from the following band: ___________________
__I have not been a member of another band
Family
Members already in the Benoit First Nation:
Name:
_____________________ Relationship: ___________BFN band #:___________
My children under 18 applying with me: (please include copies of long form birth certificates): _________________________________________________________
I am a resident of Newfoundland: Yes___
No___ If not, my Province of
residence is: _________
v Yes, I identify as a Mi’kmaw
person and maintain a connection to the Mi’kmaq community.
The historic Mi’kmaq Community I
connect to prior to 1949 is : PORT AU PORT
Certification:
I hereby certify that the information submitted herein is true and correct to
the best of my knowledge. I further certify that I am not on any other band
list.
Applicant signature: ______________________________ Date: ______________
Please mail to: Benoit First Nation,
805 Oceanview Drive, Cape St. George, NL, A0N-1T1
Please attach all required
documentation. A
Self-Addressed-Stamped-Envelope is required with each application. A $25.00 contribution/donation is required as we operate on fundraising and donations. Our website: http://www.benoitfirstnation.ca.
Please contact us the address above or by calling 709-644-2688 if you have any
questions. Email: benoitfirstnation@hotmail.com
Donation Included: $_________ (Minimum
$25.00)
BAND SECTION: Approved by: _________________________
(Signature of Chief or designate)
© Benoit
First Nation