Contractor Licence Application Natural Person

7/31/2019 Contractor Licence Application Natural Person

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Name at birth and frst name

You must indicate your name atbirth and your frst name.

FILL OUT THIS FORM, IN INK AND IN BLOCK LETTERS.

Type o application Issuing o a licence

Modifcation o a licence:Licence or fle #

1 Identifcation o the company

Name at birth First name

Other name o business (legal name)

Other name o business (legal name)

NEQ (Qubec Enterprise Number)

Civic address o the companys headquarters (P.O. box unacceptable)

Number Street Suite/Apt

Municipality Province Postal code

Area code Telephone number Ext. Area code Fax number (optional)

Area code Cell number (optional) Email address (optional)

I accept the release o the ollowing inormation in the Licence-Holders Registry (check):Telephone number Email address

Check this box i you request priority treatment. Additional cost are applied.

NEQ(Qubec Enterprise Number)

You do not have to provide a NEQi the name used in the province oQuebec or the purpose o operatingyour business enterprise includesyour frst name and last name in

ull. Example: Pierre MaltaisConstruction. I you have such anumber, it begins with the digits22.

Licence or fle #

Indicate your licence number ithis concerns an application ormodifcation o an existing licence,or your fle number i you know it.

Natural person: An individual business enterprise. An individual who makes business alone, either under his/herown name or under the name appearing on his/her declaration o registration. A natural person is inerred to be aprivate individual, as opposed to the notion o company, which designates a business enterprise.

FOR THE RBQS USE ONLY

Application #

1-

Other name o business(legal name)

Indicate any other name used inthe province o Quebec, related toyour construction activities and

appearing on the declaration oregistration at the courthouse orwith the Registraire des entreprisesdu Qubec.

For the RBQs use only

Priority treatment

In order or an applicant to beentitled to priority treatment, he/she must meet the two (2) criteriabelow:

Presents an application in ull,i.e. including the application ormflled out, the payment made tothe correct amount, the licencesecurity, etc.;

Detains the required qualifcationsin the felds or subclasses appliedor (no examination required),

To know the additional cost,consult the Fee structure section(www.rbq.gouv.qc.ca).

C

D

E

D

C

B

B

A

A E

Application or a contractors licenceNATURAL PERSON


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Rgie du btiment du Qubec 1701 Application or a contractors licence - Natural person Page 2 o

1.1 Indicate the subclass(es) applied or rom Schedule III

Carrying out o construction work (See Schedule III at www.rbq.gouv.qc.ca)

Subclass # Subclass #



Schedule III can be oundat the RBQs Web site, atwww.rbq.gouv.qc.ca,in the Licence section.

2 Identifcation o the ofcer

2.1 Identifcation

Mr. Ms.

Name at birth First name Date o birth

Home address o the natural person (P.O. box unacceptable)

Number Street Apartment

Municipality Province Postal code

Area code Telephone number Area code Fax number Area code Cell phone number

YEAR MONTH DAY

Mr. or Ms.

Check Mr. or Ms.. Check oneonly o these statuses.

Date o birth

It is important to indicate the dateo birth.


You must indicate your name atbirth and your frst name.


A

B

C D

A

B DC

PHOTOCOPY AND ADD PAGES AS REQUIRED.
http://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdf


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12.2 Qualifcation o the guarantor

Competency feld Method o evaluation

Administration Examination Training to acknowledge Proessional fle Skills already recognized

Management o saety Examination Training to acknowledge Proessional fle Skills already recognized

Management o projects Examination Training to acknowledge Proessional fle Skills already recognizedand sites

Carrying out o construction work (See Schedules I and II at www.rbq.gouv.qc.ca)Subclass # Examination Training to acknowledge Proessional fle Skills already recognized

Subclass # Examination Training to acknowledge Proessional fle Skills already recognized




Subclass # Examination Training to acknowledge Proessional fle Skills already recognizeds


Subclass # Examination Training to acknowledge Proessional fle Skills already recognizeds

In which one o the ollowing languages do you wish to take the examinations? French English

The ees or the examinations, the ees or the acknowledgement o the training and thoseor the assessment o the proessional fle are not reundable.

Competency feld

You are the sole ofcer. Only youmay act as a guarantor, and yourskills must be assessed in each oneo the felds o qualifcation.

Carrying out o construction work(See Website, Schedules I and II)

When you check the Carrying outo construction work box, you mustindicate the subclass number(s)o Schedules I and II which areapplied or.

Proessional fle

You must provide documentedproo that you possess the requiredknowledge and skills or everycompetency feld and subclasssubject to evaluation. For moreinormation, reer to the documententitled Proessional fle, which isavailable at www.rbq.gouv.qc.ca.

Skills already recognizedI you have already had certainskills recognized by the RBQ, youmight be exempted rom any newevaluation, provided that someconditions are met.

Specifcations or subclasses1.4 to 1.7

In order or any one o subclasses 1.4to 1.7 to be granted on the licence,

competency must be demonstratedwithin two (2) dierent domains,or instance Management o saety,1.4s, AND Management o projectsand sites, 1.4g. Thus, according tothe competency feld that you wishto be answering or, you wouldneed to indicate 1.4s and 1.4g(those letters corresponding to thecompetency felds).

Training to acknowledge

I you check the Training to acknow-ledge box or any feld, you mustprovide a copy o the diploma orthe equivalent certifcate relevant

to the competency feld or whichyou are applying. Reer to the Listo Training Programs Recognizedby the Rgie. Completion o one othese programs exempts you romtaking one or several examinations.I your diploma is not part o theRgies List, you will not be grantedrecognition o your training. Youshall then either have to takethe examinations, or apply oran exemption by submittinga proessional fle.

Examination

I you check this box, the RBQ willsend you a written notifcation toattend speciying the date, time andplace o the examinations. When you

decide to orward your applicationor licence, you must be ready to takethe examinations. No late arrival ator adjournment o an examinationsession shall be accepted, barring asituation beyond your control. Youmust notiy the Direction des relationsavec la clientle with a letter justiyingyour absence, otherwise your requestor adjournment could be rejected.

Indicate also i you wish to take theexaminations o the Rgie in Englishor in French. I you ail to speciythis, you will be called or taking

the examinations in French.

!

A

A

B

B

C

C

D E F G

H

F

ED
http://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdfhttp://www.rbq.gouv.qc.ca/fileadmin/medias/pdf/Publications/anglais/1592-A_Annexe_anglaise_Subclasses.pdf


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A

Mandatory declarations(questions)

Important: You must answer allquestions.

Criminal acts: The natural personmust indicate i he/she has beenound guilty, during the lastfve (5) years, o any criminal act,whether related or not related tothe construction industry.

Making a alse statement cons-titutes an oence. The RBQ mayat any time veriy and obtain thenecessary inormation or theenorcement o the Building Act.To this end, the Rgie has enteredinto agreements in particular

with the Sret du Qubec andEquiax Canada Inc.

A

A

B

C

D

2.3 Mandatory declaration o the ofcer

Have you or has your company been convicted, during the past fve (5) years:

o an indictable oence?.................................................................................................................... Yes No

o an oence under the Consumer Protection Act (OPC)? .................................................................. Yes No

o an oence under the Act Respecting Occupational Health and Saety (CSST)? .............................. Yes No

o an oence under the Act respecting labour relations,vocational training and manpower management (CCQ)? .................................................................. Yes No

o an oence under the Income Tax Act? ........................................................................................... Yes No

o an oence under the Excise Tax Act (GST)? ................................................................................... Yes No

o an oence under the Taxation Act? ................................................................................................ Yes No

o an oence under the Act respecting the ministre du Revenu? ..................................................... Yes No

o an oence under the Act respecting the Qubec sales tax (QST)? ................................................. Yes No

o an oence under any other tax law? ............................................................................................. Yes No

Have you ever fled or personal bankruptcy?............................................................................ Yes No

During the past three (3) years, have you beenthe ofcer o another business enterprise having fled or bankruptcy?................................ Yes No

Have you been the ofcer o a corporate entity or company during the 12 month periodpreceding the discontinuance o contractor activities o this corporate entity or company?..... Yes No

I Yes, indicate on a separate sheet appended the name o the corporate entity or company, its licence number,as well as the cause o the discontinuance o activities.


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3 Identifcation o the lenders - Each lender must fll out Schedule 1, Declaration o the lender

Check this box i you are applying or a modifcation o licence only and there are no changes relatedto the lenders.

I you have checked this box, go to Section 4.

Does the business enterprise have any lenders? Yes NoI you have answered No, go to Section 4.

3.1 Identifcation o the lender

Mr. Ms. Company / corporate entity


Name o business NEQ (Qubec Enterprise Number)

Home address in the case o a natural person, or civic address o headquarters, i company / corporate entity(P.O. box unacceptable)


City, village or municipality Province Postal code


YEAR MONTH DAY


I this concerns a natural person, itis important to indicate the nameat birth and the date o birth.

Name o business

I this concerns a company orcorporate entity, it is importantto indicate the legal name o thecompany or corporate entity,as well as its NEQ.

Lenders

You must identiy all lenders undermoney lending agreements,other than banking institutions,Caisses populaires and creditunions, insurance companies, trustcompanies or saving societies.Furthermore, this dispositiondoes not concern buyer accountso suppliers o services andmaterials, shareholders advances,credit lines and credit cards,nor fnancial leases.

The business enterprise (naturalperson) must supply to the RBQthe list o its lenders.

Each lender must fll out Schedule 1,

Declaration o the lender.The loan which is provided

according to the new dispositionsconcerns only the lending omoney and not the lendingo property.

Mr., Ms.,Company / corporate entity

Check Mr., Ms., or Company /corporate entity. Check one onlyo these statuses.


A

B

C

D

DB

C

A


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3.1 Identifcation o the lender








Ind. rg. N de tlphone Ind. rg. N de tlcopieur Ind. rg. N de tlphone (cellulaire)

3.1 Identifcation du prteur










YEAR MONTH DAY

YEAR MONTH DAY


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3.2 Mandatory declaration o the lender

Has any one o the lenders listed previously been convicted, during the past fve (5) years:








Please write the name o the lender concerned:

Important

You must answer all questions.

Criminal actsThe lenders must indicate i theyhave been ound guilty, during thelast fve (5) years, o any criminalact, whether related or not relatedto the construction industry.

Making a alse statement cons-titutes an oence. The RBQ mayat any time veriy and obtain thenecessary inormation or theenorcement o the Building Act.To this end, the Rgie has enteredinto agreements in particular withthe Sret du Qubec and EquiaxCanada Inc.

A

B

A

4 Mandatory licence security original

Name o the suretys company Security #

I this concerns an application or licence and i you have chosen ONLY subclasses 1.1.1 and/or 1.1.2rom Section 2 o the orm, you do not have to provide a licence security.

Security

Write the name o the surety (thename o the company or associationthat issues the security) and thenumber indicated on the documentthat certifes your security. Theoriginal o a licence security by abuilding contractor is required andmust be delivered to the RBQ bythe business enterprise or by the

surety itsel.

Please reer to the brochureentitled The licence security asrequired.

B


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Rgie du btiment du Qubec 1701 Application for a contractors licence - Natural person Page 8 of

5 Formal declaration of the guarantor

I hereby declare that all the inormation provided in this application and its appendices is truthul and complete,and that it reects my actual situation.

Last name First name

Signature Date

Making a false statement constitutes an offence.

The Rgie du btiment may at any time veriy and obtain the necessary inormation or the enorcemento the Building Act. To this end, the Rgie du btiment has entered into agreements in particular with the Sretdu Qubec and Equiax Canada Inc.

Payment

The total amount is to be paid bycheque or money order, payableto the ministre des Finances or tothe Rgie du btiment du Qubec.I you know your RBQ fle number,write it on the back o your cheque.Postdated cheques are not accepted.Do not send cash.

The original o your orm, yourpayment as well as all documentsto be enclosed must be sent to theollowing address:Centre de relation clientle (CRC)545, boul.Crmazie Est,4e tageMontral (Qubec) H2M2V2

The ee schedule can be fnd on theRBQs website (www.rbq.gouv.qc.ca)in the ee structure section.

I you wish to deliver your applicationin person, at the Centre de relationclientles counter, you may remityour payment either by cheque, bymoney order, by debit card or cash.No credit card shall be accepted.

YEAR MONTH DAY


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6 Documents to enclose

To avoid processing delays, enclose all documents required. An incomplete application could be returnedto the sender.

Original document o the l icence security.

Form completed in ull, including the original signatures.

Provide a valid Qubec Enterprise Number (NEQ) i the name used in the province o Quebec does not containyour frst name and last name in ull

A cheque to the correct amount, payable to the ministre des Finances or to the Rgie du btiment du Qubec.

Your diploma i you are applying or an acknowledgement o training (Section 2.2). Reer to the List o TrainingPrograms recognized at www.rbq.gouv.qc.ca.

I you are applying or the evaluation o your proessional fle (Section 2.3), reer to the document entitledProessional fle: Qualifcation through assessment o proessional fle o a guarantor, or a contractors licenceor an owner-builders licence, available at www.rbq.gouv.qc.ca, to learn about all the documents to be enclosed.You may also contact the Centre de relation clientle to receive a copy o this document.

A copy o the absolute order o discharge i you have answered Yes to question B o Section 2.3A transmittal letter i you have answered Yes to question D o Section 2.3

I you request priority treatment, pay double the ees.

Protection o personal inormation

The personal inormation that you are sending to the Rgie as well as that which will be added to your fle remainconfdential, with the exception o the inormation published in the RBQ Licence-Holder Register, which can beconsulted at the Rgies Web site, at www.rbq.gouv.qc.ca. The Rgie may use this inormation or the administration

and enorcement o the Building Act. Only employees assigned to the enorcement o this Act shall have access tosuch inormation, to the extent that it is necessary or the perormance o their duties.


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Rgie du btiment du Qubec 1701 Application or a contractors licence - Natural person - Schedule 1 Page 10 o


1 Declaration o the lender - section to be flled out by the lender

I the lender is a company or a corporate entity, you must also fll out the section entitled Identifcationo the lenders ofcers or each one o its ofcers. Otherwise fll out the Signature section.








During the past fve (5) years, has the abovementioned lender been convicted:








Schedule 1

YEAR MONTH DAYFor the RBQs use only


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Rgie du btiment du Qubec 1701 Application or a contractors licence - Natural person - Schedule 1 Page 11 o

1.1 Identifcation o the lenders ofcers (i lender is a company or a corporate entity)








During the past fve (5) years, has the abovementioned lender been convicted:








YEAR MONTH DAY

PHOTOCOPIEZ ET AJOUTEZ DES PAGES AU BESOIN.



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R i d bti t d Q b 1701 A li ti t t li N t l S h d l 1 P 12

1.1 Identifcation o the lenders ofcers (i lender is a company or a corporate entity)








During the past ve (5) years, has the abovementioned lender been convicted:








2 SignatureMandatory original signature o the lender or lenders ofcer

I hereby declare that all the inormation provided refects the actual situation o the lender and his/her ocers,and where the lender is a company or a corporate entity, I am authorized to sign on the lenders behal.

Last name First name

Mandatory original signature o the lender or lenders ocer Date

Protection o personal inormationThe personal inormation that you are sending to the Rgie as well as that which will be added to your le remaincondential, with the exception o the inormation published in the RBQ Licence-Holder Register, which can beconsulted at the Rgies Web site, at www.rbq.gouv.qc.ca. The Rgie may use this inormation or the administrationand enorcement o the Building Act. Only employees assigned to the enorcement o this Act shall have access tosuch inormation, to the extent that it is necessary or the perormance o their duties.


YEAR MONTH DAY

IMPORTANT : You cant send your application by email since your payment has to be enclosed. Otherwise,your application will be returned to you. Consult the Fee structure section (www.rbq.gouv.qc.ca) to know theamount to enclise.!