Educational Institution Record of Destruction
Fields denoted with an asterisk (*) are mandatory
Certificate of Destruction
By accepting and submitting this Record of Destruction document, the undersigned certifies that
the program, work, or subject-matter identified below has been destroyed.
Copy Identifier: *
Title of program, work,
or subject matter: *
Date of destruction: *
(format mm/dd/yyyy)
Person certifying
Title: *
First Name: *
Last Name: *
destruction: *
Position: *
Signature: *
Today’s Date: *
Educational Institution identifier:
(Assigned by ERCC)
Name of Educational Institution: *
City/Town/Village: *
Province or Territory: *
ERCC – EIRD Rev. E-A
Comments:
Fax or mail completed form to:
ERCC
P.O. Box 658 – 31 Adelaide Street East, TORONTO, Ontario, M5C 2J8
Fax No.: (416) 368-8324
E-mail: info@ercc.ca
ERCC – EIRD Rev. E-A