R-2.2, r. 1 - Regulation respecting the application of the Act respecting the collection of certain debts

Schedule Disposition versions

2018-01-11

FORM N-34

(Revoked)

R.R.Q., 1981, c. R-2.2, r. 1, Form N-34; O.C. 1245-2017, s. 14.

2012-09-01

FORM N-34

(s. 6)

APPLICATION FOR A COLLECTION AGENT’S PERMIT

For use of the Office de la protection du consommateur only

Class: Duties received: Date:

Application examined by: Date:

Permit number: Expiration date:

If this application is for the renewal of a permit, give the permit number:

1. Name of applicant:

2. Address of main establishment in Québec:

Postal code: Tel.:

3. Date on which the applicant began to do business as a collection agent in Québec:

4. Number of branches in Québec: (attach a list of their addresses)

5. If the applicant is a natural person, give:

(a) his date of birth:

(b) his social insurance number:

6. Does the applicant carry on, alone or in a partnership, any other business that is subject to a permit under an Act the application of which is under the supervision of the Office de la protection du consommateur?

yes □ no □

7. If so, give the following information:

Name:

Address: Tel.:

Type of business:

Permit number:

8. Total annual value of amounts collected during the last fiscal period:

9. Number of representatives:

10. Does the applicant hold a permit or licence to operate his business elsewhere than in Québec?

yes □ no □

Place: (province, state or country) Permit or licence No.:

11. Has the applicant already been refused a collection agent’s permit?

yes □ no □

12. If so, give particulars:

13. Is the applicant an undischarged bankrupt?

yes □ no □

14. If so, give particulars: (reasons, number of court record)

15. During the last 3 years, has the applicant been found guilty of:

(a) an offence against any Act or regulation the application of which is under the supervision of the Office?

yes □ no □

(b) an indictable offence?

yes □ no □

(c) an offence punishable on summary conviction under Part IX or under section 423 or 426 of the Criminal Code (R.S.C. 1985, c. C-46)?

yes □ no □

16. If so, specify: (nature of offence, date of judgment, number of court record, etc.)

17. The following documents are included with this application:

(1) a copy of the declaration under the Act respecting the legal publicity of enterprises (chapter P-44.1) if the applicant is a natural person who operates a collection agency under a name which does not include the person’s surname and given name (if this application is for the renewal of a permit and if the copy of the declaration is identical, please ignore this item) □

(2) a list of the names and addresses of the applicant’s representatives □

(3) security:

(a) individual guarantee bond □

(b) certificate of member covered by a group guarantee bond □

(c) cash □ certified cheque □ postal money order □ bank money order □ order to pay □

(d) bond □

(4) duties: cheques □ postal money order □ bank money order □ order to pay □

Any cheque, postal or bank money order, or order to pay must be made to the order of the Minister of Finance.

18. The applicant agrees to provide any additional information required by the Office de la protection du consommateur. If the applicant is a partnership or legal person, it must provide the following additional information:

19. Is one of the partners or directors an undischarged bankrupt?

yes □ no □

20. If so, give particulars:

Name: Number of court record:

Name: Number of court record:

21. Within the last 3 years, has one of the partners or directors been found guilty of:

(a) an offence against any Act or regulation the application of which is under the supervision of the Office?

yes □ no □

(b) an indictable offence?

yes □ no □

(c) an offence punishable on summary conviction under Part IX or under section 423 or 426 of the Criminal Code?

yes □ no □

22. If so, give particulars: (nature of offence, date of judgment, number of court record, etc.)

23. The following documents are included with this application:

(a) a copy of the declaration of the partnership or, where applicable, a copy of the letters patent and supplementary letters patent or of any other constituting act (if this application is for the renewal of a permit, please ignore this item) □

(b) a list of names, dates of birth, social insurance numbers, personal addresses, and functions of the partners or directors in the partnership or legal person. □

24. Date of fiscal period of applicant:

25. An applicant that is a foreign legal person must provide proof of registration under the Act respecting the legal publicity of enterprises (chapter P-44.1).

I ______________________________, applicant or authorized signatory of the partnership or legal person, declare that the information given in this application and in all documents annexed hereto is true and complete.

Signed at ____________________ this __________day of __________(month)__________ 20__________

________________________________________

Signature of the applicant or authorized signatory

________________________________________

Function in the partnership or legal person

Any false declaration renders the applicant liable to the penalties provided for in the Act respecting the collection of certain debts (chapter R-2.2).

R.R.Q., 1981, c. R-2.2, r. 1, Form N-34.