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United Grand Lodge of England
FORM OF APPLICATION FOR GRAND LODGE CERTIFICATES

 LP & A5
Received via e-mail
from the
meeting at

This form must be used only for Brethren whose names have already been registered and registration fees paid, and should be used immediately after the Brethren concerned have been raised and have received the Traditional History, following which only is the ceremony of raising complete.

If you do not receive a Certificate within 28 days of submitting this form, please e-mail: registration@ugle.org.uk

Surname Christian or Forenames in Full Date of
Initiation		 Date of
Passing		 Date of
Raising
Please ensure that the details supplied above have been checked against the Lodge records before being submitted.           Dates must be entered in dd/mm/yyyy or dd/mm/yy format.

Remarks:
Secretary's details      'e-mail address' and 'Name' are mandatory fields
e-mail address N.B.: Please indicate if there is any alteration in Name and/or Address of Secretary

Yes

Name
Address
Post Code Date

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