Designated Master Transfer Request

I understand that the information I provide within this application must be true, complete and original. If I make a false statement and/or upload tampered/forged supporting documentation on this application, my license will be revoked and I will be permanently barred from consideration of licensure to practice in the industrial trades industry in the District of Columbia.

Action Requested

License Type

Contracting Company Information

Company Name

Company License Number

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Phone Number

Email Address (Input contracting company's email address. Providing an incorrect email address for the contracting company will cause your transfer request to be dishonored)

Current Designated Master Information

D.C. License Number

New Designated Master Information

D.C. License Number

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Upload New Bond and Power-of-Attorney

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Designated Master Information

D.C. License Number

Upload Master License

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Do you have outstanding permits that you obtained as the Designated Master for this contracting company?

List Outstanding Permits Below (i.e., P123456)

Phone Number

I formally request and consent to replace the current designated master with the specified new designated master.

I formally request and consent to remove my Designated Master license from the contracting company indicated above.

I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.

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First Name

Last Name

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Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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