I, the undersigned ______________________________, land surveyor,(registration number ____________________ ) declare, under my oath of office, that I am exempt from subscribing to the group insurance plan of the Order for one of the following reasons:
(1) I am not in professional practice on my own account, either on a part-time or a full-time basis, alone or as member of a partnership, nor am I employed in any manner whatsoever by an individual land surveyor, a partnership, a joint-stock company or a company in which the Government is not majority shareholder: I practice my profession exclusively for ______________________________;
and outside the framework of such employment I do none of the tasks mentioned in section 34 of the Land Surveyors Act (chapter A-23), namely:
(a) the surveying of land, the taking of measurements for boundary purposes; the drawing of boundaries, mapping, the drawing up of all types of maps, minutes, reports, territorial descriptions, certificates of localization as well as all documents and operations made by direct, photogrammetric, electronic or other methods connected in any way with the fixing of boundaries, the laying out of lots, establishing the seat of servitudes, the staking of lots and the scaling of lakes, rivers and other bodies of water in Québec, with calculating the area of public and private property, all cadastral operations, or compiling of lots or parts thereof and cartographic description of territory for the aforesaid purposes;
(b) establishing and updating a skeletal map of geodetic points to any degree of precision and the defining of photogrammetric controls for purposes listed in paragraph a;
(2) I am enrolled as member of the Ordre des arpenteurs-géomètres du Québec and under no circumstances whatsoever do I carry out any of the tasks mentioned in section 34 of the Land Surveyors Act. I agree not to perform any of the said tasks, and, outside the employment framework to which paragraph 1 refers, not to sign or certify, within the meaning of section 36 of the Land Surveyors Act, any document connected with land surveying or an operation defined in section 34 of the said Act.
I also promise to immediately advise the Ordre if I begin to practise professionally under any of the terms prescribed by section 2 of this Regulation and to subscribe to the group insurance plan.
DATE ___________________________________ ___________________________________