11.4. The travel counsellor must, when applying for the issue or renewal of the certificate, send to the president, on the form provided by the president, the following information:(a) the counsellor’s name, domicile address, date of birth, personal and professional telephone numbers and, where applicable, personal and professional technological address and fax number;
(b) the name, address and licence number of the travel agent to whom the counsellor is bound by an exclusive employment or service contract;
(c) a declaration according to which the counsellor has not committed, in the 5 years preceding the application, an offence against the Act or this Regulation;
(d) a declaration according to which the counsellor has not been found guilty, in the 5 years preceding the application, of fraud, forgery or fraudulent operations in contractual or commercial matters;
(e) a declaration according to which the counsellor has not made a false or misleading declaration or failed to mention an important fact for obtaining the certificate.