Form withdraw/cancel CoC | CMI Certification

Welcome to the Withdrawal/Cancellation Form

Please note the * fields are mandatory.

"*" indicates required fields

Organisation Details

Please confirm the information that CMI currently has on file for your organisation.
This information will allow your request to be authorised and efficiently processed by our Team Members.

Name of the Organisation*

Current Point of Contact*

First Last

Current Email Address*

Certificate Details

Scheme Applicable*

CMI ProdCert

CodeMark Australia

WaterMark

Product Name*

License Number*

Requested Withdrawal/Cancellation Date

Next scheduled Surveillance/Expiry date

Date prior to the Surveillance/Expiry date

Date*

Changes and Supporting Evidence

Supporting Documentation*

A formal letter or the company letterhead must be supplied, signed off by the point of contact or someone else appropriately authorised to cancel the certification. Allowed file types: pdf, doc, docx, xls, xlsx - Max 10 files, 1MB each.

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 1 MB, Max. files: 10.

Acceptance

CMI Certification reserves the right to correspond with existing authorised representatives
and ask for further information as deemed necessary to confirm the information supplied.

1. The undersigned warrants all information supplied is true and correct.
2. The undersigned is an approved Point of Contact.
3. The undersigned acknowledges that once a Withdrawl/Cancellation has been processed the license number is no longer able to be used and must be removed in line with the relevant scheme rules.

I confirm that I have read and agree to the conditions set forth on this form as well as the CMI Terms and Conditions.

Name*

First Last

By typing your Full Name you legally sign this document and agree to the above.

Date*

Name

This field is for validation purposes and should be left unchanged.