Registration form for the 2020 Patent Agent Qualifying Examination

Application for the 2020 Patent Agent Qualifying Examination (Section 12(a) of the Patent Regulations)

The information recorded in this document is compiled by the Patent Appeal Board for applications to the 2020 Patent Agent Qualifying Examination. Personal information will be protected under the Privacy Act.

Registration form – Administrative information

Last name: space to insert last name

First name: space to insert first name

Gender: 

Preferred official language of correspondance:

Mailing address:

Choice of paper :

Telephone: space to insert telephone

Other telephone: space to insert other telephone

Email (mandatory): space to insert email

Other email: space to insert other email

In which official language would you prefer to write the exam?

In what city would you like to write the exam?: space to insert city

On a volunteer basis for statistical purposes : level of education and profession: space to insert level of education and profession

Registration application declaration

Please complete the form below to enable us to establish that you satisfy the eligibility conditions for the Patent Agent Qualifying Examination:

I certify that I meet the requirements stipulated in section 12(a) of the Patent Regulations

My application includes: an affidavit or statutory declaration.

My application includes: a letter of attestation signed by my employer or certified Patent Agent.

My payment fee form is included.

If applicable, my special accommodations form is included (all requests for accommodation must be clearly indicated at the time of the application, and sent by ).

Candidate's signature  space to insert signature

Date space to insert date

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