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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