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Lost Certificate Replacement Form

Replace your certificate

We charge $15.00 fee to replace a lost or damaged certificate. Please fill-up the form very carefully. Please provide complete name of the student as it appears in the birth certificate. Also please provide complete mailing address.! If you have any questions please call or text at (510)20163161.
*Student's Name: *Required fields
*Date of Birth:
*Mailing Address:
*Zip Code:
*Phone Number:
*Your Email:
*Select Your Certificate:
Cost: Never received certificate or lost in mail (No charge if within 30 days)
Original certificate lost or destroyed ($15.00 replacement fee)
*Enter Contents of the image:

You will be taken to PayPal's secure site for processing and then returned to the beginning of our course. We will have no record of your credit card information on file, only verification from PayPal that you have paid for the course.