Government of Ontario: Ministry of Government and Consumer Services

Consumer Services Operations Division
77 Wellesley Street West
PO Box 450
Toronto ON  M7A 2J6
Telephone:    416-326-8800
Toll free:        1-800-889-9768
TTY:              416-229-6086
TTY toll free: 1-877-666-6545

Application for Registration or Appointment
(Business) - New, Reinstatement or Renewal

Note to Applicants:

Bailiffs: complete sections
Sole Proprietor 1 to 4; 6; 7; 9 to 19
Partnership 1 to 4; 6; 7; 9 to 19
Corporation 1 to 7; 9 to 19

Collection Agencies and Consumer Reporting Agencies: complete sections
Sole Proprietor 1 to 4; 6; 9 to 19
Partnership 1 to 4; 6; 9 to 19
Corporation 1 to 6; 9 to 19
Branch 1 to 4; 8; 9 to 19

FOR CPB OFFICE USE ONLY



1. The applicant hereby applies for the following: check appropriate type
Application for:



2. Business Application Type

        

3. Application Type

     

4. For the purpose of this application the applicant provides the following information





Business Address


Street Number




Telephone Number (incl. Area Code)
Fax Number (incl. Area Code)


Contact Telephone Number (incl. Area Code)
Mailing Address (if different from Business Address)


Street Number




If a Sole Proprietor, are you a Canadian Citizen?

  

5. For Corporations Only (if the shareholder is another Corporation include a fully completed form)

Jurisdiction of Incorporation

     

1.



2.



3.



4.




Is the corporation entitled to offer its shares to the public?

  

Are any of the equity (voting) shares held for a beneficial Shareholder?
If yes, attach full particulars

  

6. For Collection Agencies



Address of Financial Institution







7. For Bailiffs Only
Have you attached an ORIGINAL bond in the amount of $5,000.00?

  

NOTE: List qualifications to act as a bailiff on a separate sheet and include résumé.
If the application is in respect of a corporation, include qualifications and résumé of each active officer and director.


8. Notices and Consent under the Freedom of Information and Protection of Privacy Act (Applicant)

I/We understand that in order to complete and verify the information provided in this application, Ministry of Government and Consumer Services, Consumer Services Operations Division may consult with licensing or regulatory authorities, government regulators or other law enforcement agencies in or out of Canada, the Registrar of Bankruptcies, credit bureaus, professional and industry associations, former or current employers, employers for whom I may be associated with while this appointment, licence or registration is valid and may collect additional relevant information.

I/We also understand that the information collected pursuant to this application or in relation to the conduct as a licensee, registrant or appointee under the Act to which this application is made, may be shared with regulating authorities or law enforcement agencies in other jurisdictions and that such information may be used in determining the license, registration or appointment status in all jurisdictions in which the applicant is licensed, registered or appointed or has applied to be licensed, registered or appointed.

I/We consent to the collection and use of this information to determine whether I am/we are and remain, or the applicant is and remains qualified for licensing, registration or appointment in all jurisdictions.

I/We further consent to the Ministry informing my/our current, subsequent or intended employer(s) of any action taken and of any information gathered in relation to this licence, registration or appointment.

.

1.




2.




3.




NOTE: For Corporations, an officer must sign this application.
For Partnerships, each partner in a partnership must sign this application.
For a Sole Proprietorship, the sole proprietor must sign this application.

The public official who can answer questions about the collection of this information is:

Ministry of Government and Consumer Services
Consumer Services Operations Division
77 Wellesley Street West
PO Box 450
Toronto ON M7A 2J6
Telephone: 416-326-8800
Toll free: 1-800-889-9768
TTY: 416-229-6086
TTY toll free: 1-877-666-6545

9. Key Individuals

(Attach a completed copy of this page (page 3) and the following pages (page 4 & 5), for each officer, director, partner, sole proprietor)

Name



Canadian Resident

  

Sex   
Position Held

              

For Bailiff or Collection Agency Applicants only
(partner, sole proprietorship or active officer or director
of a corporate application must pass an examination)

I will be active in the business to which this application pertains
On I successfully passed the Bailiff examination.
On I successfully passed the Collection Agency examination

Residential Address








Telephone Number (incl. Area Code)
Fax Number (incl. Area Code)

10. – 18. Key Individuals and Applicants

If the answer to any of the following questions is “YES” attach full details on a separate signed and dated sheet.
Also attach any relevant documentation

It is a serious offence to make a false statement in this application. A false statement may delay the processing of this application and result in the refusal of the application and possible charges.

10. Will you be engaged, occupied, employed or associated directly or
indirectly, in any other business, occupation or profession?
Check Appropriate Response



11. Are you registered, licenced or appointed under this or any other
legislation in any province, territory, state or country? (other than related
to a driver’s licence)

Check Appropriate Response



12. Do you currently have any unpaid judgment(s) outstanding against you?
Are you or were you an officer, director or controlling shareholder of a
corporation, which has any unpaid judgment(s) outstanding?
Check Appropriate Response



13. Have you ever had a registration, licence or appointment refused,
suspended, revoked or cancelled? (other than related to a driver’s licence)
Check Appropriate Response


14. Have you ever been an officer, director or controlling shareholder of a
corporation that has had a registration, licence or appointment, refused,
suspended, revoked or cancelled?
Check Appropriate Response



15. Have you, in the past ten (10) years, been involved in bankruptcy
proceedings, or are you now or have you been an officer, director or
controlling shareholder of a corporation which has in the last ten (10)
years been declared bankrupt or is currently a party to bankruptcy
proceedings?
Check Appropriate Response



16. Have you ever been convicted of an offence under any law of any
province, territory, state or country, or are you currently the subject of
any charges?
(You do not have to disclose any offence for which a pardon has been
granted under the Criminal Records Act and which has not been revoked.
(A pardon is not granted simply because of the passage of time.) You do
not have to disclose convictions under the Young Offenders Act, the
Juvenile Delinquents Act or minor traffic violations such as speeding or
parking tickets.)

Check Appropriate Response



17. Have you ever been an officer, director or controlling shareholder of a
corporation which has been convicted of an offence under any law of any
province, territory, state or country, or is currently the subject of any
charges?
Check Appropriate Response



18. Have you ever had an employment or business relationship terminated for
breach of trust or confidentiality, deceit, fraud, theft, forgery,
misappropriation of funds, harassment or assault or other similar
conduct?
Check Appropriate Response



I hereby certify that the information provided is, to the best of my knowledge and belief, true.
.



19. Notices and Consent under the Freedom of Information and Protection of Privacy Act (Individual)

I understand that in order to complete and verify the information provided in this application, Ministry of Government and Consumer Services, Consumer Services Operations Division may consult with licensing or regulatory authorities, government regulators or other law enforcement agencies in or out of Canada, the Registrar of Bankruptcies, credit bureaus, professional and industry associations, former or current employers, employers for whom I may be associated with while this appointment, licence or registration is valid and may collect additional relevant information.

I also understand that the information collected pursuant to this application or in relation to the conduct as a licensee, registrant or appointee under the Act to which this application is made, may be shared with regulating authorities or law enforcement agencies in other jurisdictions and that such information may be used in determining the license, registration or appointment status in all jurisdictions in which the applicant is licensed, registered or appointed or has applied to be licensed, registered or appointed.

I consent to the collection and use of this information to determine whether I am and remain, or the applicant is and remains qualified for licensing, registration or appointment in all jurisdictions.

I further consent to the Ministry informing my current, subsequent or intended employer(s) of any action taken and of any information gathered in relation to this licence, registration or appointment.

.



The public official who can answer questions about the collection of this information is:

Ministry of Government and Consumer Services
Consumer Services Operations Division
77 Wellesley Street West
PO Box 450
Toronto ON M7A 2J6
Telephone: 416-326-8800
Toll free: 1-800-889-9768
TTY: 416-229-6086
TTY toll free: 1-877-666-6545