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Application to Postpone or Cancel Examination

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					                                                             Application to Postpone or Cancel
                                                                                  Examination

1. PERSONAL INFORMATION (IN BLOCK LETTERS)
Ms           Mr.
Last name:                                                              First name:

Personal identification number (PIN):             –          –                   Date of birth:                 /           /
                                                                                                        year        month        day


                                             This information is important for your file.
                         If you already provided this information and it has not changed, go to section 2.

Residential address

No.                  Street                           Apt.         City                        Province                         Postal code

Telephone (residence): _____________________                       Telephone (business):                                        Ext.: _______

Cell phone: ______________________________                         E-mail:

Language of correspondence:              French         English


2. EXAMINATIONS TO POSTPONE OR CANCEL
Please provide the necessary information to postpone or cancel one or more examinations.
                                                                    Examination date and
                                                                       time in order of                  Location of
                           Examination         Original
      Application                                                         preference                     examination                   Language
                              No.          examination date
                                                                    (example: April 6, 2010,              (if changed)
                                                                          time slot A)
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible
                                                                   1.                              From:                                French
 Postponement                            _______________
                                                                   2.
 Cancellation                             day / month / year                                       To:                                  English
                                                                        As soon as possible

                                                                        Date:          /            /
Signature of applicant                                                          year       month          day


Website: www.lautorite.qc.ca                                                                                                aut-dema-repo-0310an
Information Centre: 514-395-0337, 418-525-0337 or 1-877-525-0337
3. FEES
Postponement

    A fee of $62 is payable:

    •    if the AMF receives your application five working days or more before the examination date indicated on your
         notice of examination;
    •    if your examinations are spread over a period of three months and the new examination date falls within this
         period.

    A fee of $188 is payable:

    •    if the AMF receives your application four working days or less before the examination date indicated on your
         notice of examination;
    •    if your examinations are staggered over a period of three months and the new examination date falls after this
         period.
                                                                                         If payment is made with a credit card, please carry
                                                                                         the amount over the space below marked by an *.

Cancellation

    File opening fees and administration fees are not refundable. If you cancel your registration application five working
    days or more before the date chosen for the examination session, the registration fees will be refunded in addition to
    the fees for the disclosure of examination results, but only if you have not yet passed an exam. If you cancel your
    registration application four working days or less before the date chosen for the examination session, only the fees
    for the disclosure of examination results will be refunded but only if you have not yet passed an exam.


Method of payment

     Cheque                  Payable to the order of the Autorité des marchés financiers
     Money order             and dated the day on which you send your form.

     Visa
     MasterCard

Card No.: __________ / _________ / ________ / _________ Expiry date: __________ / _________
                                                                  month        year

I authorize the AMF to charge the amount of * $                    to my credit card.



Name of cardholder (block letters)

                                                                              Date:            /           /
Signature of cardholder                                                                 year       month       day



You may send your form:

•   by fax: 514 849-7012 or

•   by mail:

    Autorité des marchés financiers
    Direction de la formation et de la qualification
    800, square Victoria, 22e étage
    C.P. 246, tour de la Bourse
    Montréal (Québec) H4Z 1G3




Website: www.lautorite.qc.ca                                                                                         aut-dema-repo-0310an
Information Centre: 514-395-0337, 418-525-0337 or 1-877-525-0337

				
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