NOTE: As of June 4, 2009, all fields marked with an asterisk are required. If you use your home address as your corporation address, it will be publicly available on the College Register. Review your Optometry Professional Corporation information on the College Register.
APPLICATION FOR RENEWAL FOR A CERTIFICATE OF AUTHORIZATION (COA) FOR AN OPTOMETRY PROFESSIONAL CORPORATION
*FULL NAME OF ALL SHAREHOLDERS ASSOCATIED WITH THE CORPORATION
COLLEGE REGISTRATION NUMBER
All officers & directors must be shareholders
(If different than corporate business address)
Have there been any changes in the year since the issuance or most recent renewal of the corporation's certificate of authorization?
DECLARATION FOR A RENEWAL OF A CERTIFICATE OF AUTHORIZATION
Signed and dated by a director of the corporation not more than 15 days before submission to the College of Optometrists of Ontario
I, , holding College registration number , am a director of , and do hereby declare the following:
i. that the corporation is in compliance with section 3.2 of the Business Corporations Act as of the date this declaration is signed,
ii. that the corporation does not carry on, and does not plan to carry on, any business that is not the practice of the profession governed by the College or activities related to or ancillary to the practice of that profession,
iii. that there has been no change in the status of the corporation since the date of the corporation profile report enclosed with this application for a renewal of a Certificate of Authorization,
iv. that the information contained in the Renewal Form for a Certificate of Authorization that accompanies this declaration is complete and accurate as of the date this declaration is signed.