Registration form for the 2019 Trademark Agent Qualifying Examination
Application for the 2019 Trademark Agent Qualifying Examination (section 16 of the Trademarks Regulations).
The information recorded in this document is compiled by the Patent Appeal Board for applications to the 2019 Trademark Agent Qualifying Examination. Personal information will be protected under the Privacy Act.
Registration form – Administrative information
Last name: _________________________________________
First name: _________________________________________
Gender:
Preferred official language of correspondance:
Mailing address:
Telephone: _________________________________________
Other telephone: _________________________________________
Email (mandatory): _________________________________________
Other email: _________________________________________
In which official language would you prefer to write the exam?
In what city would you like to write the exam?: _________________________________________
On a volunteer basis for statistical purposes: 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 Trademark Agent Qualifying Examination:
I certify that I meet the requirements stipulated in section 16 of the Trademarks Regulations
My application includes an affidavit or statutory declaration by myself.
My application includes a letter of attestation signed by my employer or certified Trademark 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, but sent no later than 45 days prior to the date of the scheduled examination, ( i.e. before Friday, October 11, 2019)
Candidate's signature ________________________________
Date ________________________________
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