APPLICATION FOR PERMIT TO PRACTICE AS A
PARTNERSHIP, CORPORATION OR OTHER ENTITY

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Branch Offices are located at:


Declaration by Chief Operating Officer or his Authorized Designate

I _______________________ occupy the position of ________________________________
in the applicant's organization and in that position have authority and undertake to maintain an organization in which the practice of the professions indicated above can be conducted in accordance with requirements described in The Engineering, Geological and Geophysical Professions Act with specific reference to Parts 1 & 4 of the Act and Part 7 of the Regulations.

I further undertake:

(a) To notify the Registrar in writing forthwith if the professional members or licensees of APEGGA who have assumed responsibility for the professional practice cease to be full time employees or shareholders of the applicant.

(b) To surrender permit stamps and certificates to the Registrar in circumstances where there are not members or licensees of APEGGA assuming responsibility for the professional practice of the applicant.

(c) To report on an annual basis the names of

(i) Chief Operating Officer or his designate taking corporate responsibility for the applicant.

(ii) APEGGA members or licensees assuming responsibility for direction of the professional practice of the applicant.
(Signature) (Date)
   
Enclosed is my cheque for $ 205.00 (G.S.T. exempt) made payable to APEGGA or
 Visa    MasterCard    #________________   Expiry Date:_____________________________
For Office Use Only

  Permit No.________   Fee: $_________________   Approved________________________
          (Registrar)

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