FILL OUT THIS FORM, IN INK N IN LOK LETTERS. pplication for a contractor s licence NTURL PERSON Type of application Issuing of a licence 1 For the MMTQ s use only Name at birth First name Other names of business (legal name) Other names of business (legal name) ivic address of the company s headquarters (P.O. box only is unacceptable) Number Street Suite/pt Municipality Province Postal code rea code Telephone number Ext. rea code Fax number (optional) rea code ell number (optional) E-mail address (optional) I accept the release of the following information in the Licence-Holders Registry (check): Telephone number E-mail address E heck this box if you request priority treatment. dditional cost are applied. Indicate your licence number if this concerns an application for Other name of business (legal name) Indicate any other name used in the province of Quebec, related to your construction activities and appearing on the declaration of registration at the courthouse or with the Registraire des entreprises du Québec. You must indicate your name at NEQ (Québec Enterprise Number) You do not have to provide a NEQ if the name used in the province of Quebec for the purpose of operating your business includes full. Example: Pierre Maltais onstruction. If you have such a number, it begins with 22. E Priority treatment In order for an applicant to be entitled to priority treatment, he/ she must meet the two (2) criteria below: Present an application in full, i.e. including the application form the correct amount, the licence security, etc.; Hold for (no examination required). Natural person: n individual business. n individual who makes business alone, either under his/her own name or under the name appearing on his/her declaration of registration. natural person is referred to as a private individual, as opposed to the notion of company, which designates a business. MMTQ Février 2012 FOR THE MMTQ S USE ONLY 1- pplication # Page 1 of 12
PHOTOOPY N PGES S REQUIRE. 1.1 Indicate the subclass(es) applied for from Schedule III arrying out of construction work (See Schedule III at www.cmmtq.org) Subclass # Subclass # Subclass # Subclass # Subclass # Subclass # Schedule III can be found at the MMTQ s Web site, at www.cmmtq.org, in the Qualification des membres section. 2 2.1 Mr. Ms. For the MMTQ s use only YER MONTH Y Home address of the natural person (P.O. box only is unacceptable) Number Street partment Municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number Mr. or Ms. heck Mr. or Ms.. heck one only of these statuses. You must indicate your name at ate of birth It is important to indicate the date of birth. pplication for a contractor s licence - Natural person Page 2 of 12
1 2.2! Method of evaluation dministration Examination Training to acknowledge Skills already recognized Management of safety Examination Training to acknowledge Skills already recognized Management of projects Examination Training to acknowledge Skills already recognized and sites arrying out of construction work (See Schedules I and II at www.cmmtq.org) E F G In which one of the following languages do you wish to take the examinations? French English The fees for the examinations, the fees for the acknowledgement of the training and those may act as a guarantor, and your skills must be assessed in each one arrying out of construction work (See Website, Schedules I and II) When you check the arrying out of construction work box, you must indicate the subclass number(s) of Schedules I and II which are applied for. 1.4 to 1.7 In order for any one of subclasses 1.4 to 1.7 to be granted on the licence, competency must be demonstrated within two different domains, for instance Management of safety, 1.4s, N Management of projects and sites, 1.4g. Thus, according to to be answering for, you would need to indicate 1.4s and 1.4g (those letters corresponding to the Examination If you check this box, the MMTQ will F attend specifying the date, time and place of the examinations. When you decide to forward your application for licence, you must be ready to take the examinations. No late arrival at or postponement of an examination session shall be accepted, barring a situation beyond your control. You must notify Qualification epartment with a letter justifying your absence, otherwise your request for postponement could be rejected. Indicate also if you wish to take the examinations of the MMTQ in English or in French. If you fail to specify this, you will be called for taking the examinations in French. You must provide documented proof that you possess the required knowledge and skills for every subject to evaluation. For more information, refer to the document entitled Qualification par dossier professionnel d un répondant pour une licence d entrepreneur, which is available at www.cmmtq.org. E G Training to acknowledge If you check the Training to acknowledge box, you must enclose a copy of the diploma or certification corresponding to the competency field that you wish the MMTQ to recognize. For more information, refer to the document entitled Registre de programmes de formation reconnus aux fins d exemption des examens which is available at www.cmmtq.org. ompletion of one of these programs exempts you from taking one or several examinations. If your diploma is not part of the MMTQ s List, you will not be granted recognition of your training. You shall then either have to take the examinations, or apply for an exemption by submitting a professional file. Skills already recognized If you have already had certain skills recognized, you might be exempted from any new evaluation, provided that some conditions are met. pplication for a contractor s licence - Natural person Page 3 of 12
2.3 of an indictable offence?... Yes No of an offence under the onsumer Protection ct (OP)?... Yes No of an offence under the ct Respecting Occupational Health and Safety (SST)?... Yes No of an offence under the ct respecting labour relations, vocational training and manpower management (Q)?... Yes No of an offence under the Income Tax ct?... Yes No of an offence under the Excise Tax ct (GST)?... Yes No of an offence under the Taxation ct?... Yes No of an offence under the ct respecting the ministère du Revenu?... Yes No of an offence under the ct respecting the Québec sales tax (QST)?... Yes No of an offence under any other tax law?... Yes No l... Yes No uring the last 3 years, have you been... Yes No partnership months preceding the discontinuance of contractor activities of this partnership or company?... Yes No If Yes, indicate on a separate sheet appended the name of the partnership or company, its licence number, as well as the cause of the discontinuance of activities. Mandatory declarations (questions) Important: You must answer all questions. riminal acts: The natural person must indicate if he/she has been found guilty, during the last whether related or not related to the construction industry. Making a false statement constitutes an offence. The MMTQ or, where appropriate, the RQ and the MEQ, may at any time verify and obtain the necessary information for the enforcement of the uilding ct through agreements made in particular with the Sûreté du Québec and equifax anada Inc. for background checks and past behavior. pplication for a contractor s licence - Natural person Page 4 of 12
3 to the lenders. If you have checked this box, go to Section 4. e are no changes related oes the business have any lenders? Yes No If you have answered No, go to Section 4. 3.1 Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number Lenders You must declare all lenders under money lending agreements, other than banking institutions, aisses populaires and credit unions, insurance companies, trust companies or saving societies. Furthermore, this declaration is not applicable to buyer accounts of suppliers of services and materials, shareholders advances, credit lines and credit cards, nor financial leases. The business (natural person) must provide the MMTQ with the list of its lenders. Each lender must fill out Schedule 1, eclaration of the lender. The loan which is provided according to the new declaration concerns only the lending of money and not the lending of property. Mr., Ms., ompany / partnership partnership. heck one only of these statuses. If this concerns a natural person, it is important to indicate the name at birth and the date of birth. If this concerns a company or partnership it is important to indicate the legal name of the company or partnership, as well as its NEQ. pplication for a contractor s licence - Natural person Page 5 of 12
PHOTOOPY N PGES S REQUIRE. 3.1 Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number Ind. rég. Ind. rég. N de téléphone (cellulaire) 3.1 Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number pplication for a contractor s licence - Natural person Page 6 of 12
3.2 Mandatory declaration of the lender last 5 years: of an indictable offence?... Yes No of an offence under the Income Tax ct?... Yes No of an offence under the Excise Tax ct (GST)?... Yes No of an offence under the Taxation ct?... Yes No of an offence under the ct respecting the ministère du Revenu?... Yes No of an offence under the ct respecting the Québec sales tax (QST)?... Yes No of an offence under any other tax law?... Yes No Please write the name of the lender concerned: Important You must answer all questions. riminal acts The lenders must indicate if they have been found guilty, during the last five years, of any criminal act, whether related or not related to the construction industry. Making a false statement constitutes an offence. The MMTQ or, where appropriate, the RQ and the MEQ, may at any time verify and obtain the necessary information for the enforcement of the uilding ct through agreements made in particular with the Sûreté du Québec and Equifax anada Inc. for background checks and past behavior. Security Write the name of the surety (the name of the company or association that issues the security) and the number indicated on the document that certifies your security. The original of a licence security by a building contractor is required and must be delivered to the MMTQ by the business or by the surety itself. For more information, refer to the section entitled autionnement de licence, which is available at www.cmmtq.org. 4 Mandatory licence security original Name of the surety s company Security # pplication for a contractor s licence - Natural person Page 7 of 12
5 Formal declaration of the guarantor I hereby declare that all the information provided in this application and its appendices is truthful and complete, Last name First name YER MONTH Y Signature ate Making a false statement constitutes an offence. The MMTQ or, where appropriate, the RQ and the MEQ, may at any time verify and obtain the necessary information for the enforcement of the uilding ct through agreements made in particular with the Sûreté du Québec and Equifax anada Inc. for background checks and past behavior. Payment The total amount is to be paid by cheque or money order, payable to the MMTQ. If you know your file number, write it on the back of your cheque. Postdated cheques are not accepted. o not send cash. The original of your form, your payment as well as all documents to be enclosed must be sent to the following address: MMTQ Qualification epartment 8175, boul. St-Laurent Montréal Qc H2M 2V2 If you wish to deliver your application in person, you may remit your payment either by cheque, by money order, by debit card or cash. No credit card shall be accepted. pplication for a contractor s licence - Natural person Page 8 of 12
6 ocuments to enclose To avoid processing delays, enclose all documents required. n incomplete application could be returned to the sender. Original document of the licence security. Form completed in full, including the original signatures. Provide a valid Québec Enterprise Number (NEQ) if the name used in the province of Quebec does not contain cheque to the correct amount, payable to the MMTQ. Your diploma if you are applying for an acknowledgement of training (Section 2.2). Refer to the Registre de programmes de formation reconnus aux fins d exemption des examens at www.cmmtq.org refer to the document entitled Qualification par dossier professionnel d un répondant pour une licence d entrepreneur at www.cmmtq.org to learn about all the documents to be enclosed. You may also contact the Qualification epartment to receive a copy of this document. copy of the absolute order of discharge if you have answered Yes to question of Section 2.3 explanatory letter if you have answered Yes to question of Section 2.3 If you request priority treatment, pay double the fees. Protection of personal information MMTQ y consulted at the Régie s Web site, at www.rbq.gouv.qc.ca. The MMTQ may use this information for the administration and enforcement of the uilding ct. Only employees assigned to the enforcement of this ct shall have access to such information, to the extent that it is necessary for the performance of their duties. pplication for a contractor s licence - Natural person Page 9 of 12
PHOTOOPY N PGES S REQUIRE. Schedule 1 1 eclaration of the lender partnership Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number of an indictable offence?... Yes No of an offence under the Income Tax ct?... Yes No of an offence under the Excise Tax ct (GST)?... Yes No of an offence under the Taxation ct?... Yes No of an offence under the ct respecting the ministère du Revenu?... Yes No of an offence under the ct respecting the Québec sales tax (QST)?... Yes No of an offence under any other tax law?... Yes No pplication for a contractor s licence - Natural person - Schedule 1 Page 10 of 12
PHOTOOPY N PGES S REQUIRE 1.1 s (if lender is a company or a partnership) Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number l of an indictable offence?... Yes No of an offence under the Income Tax ct?... Yes No of an offence under the Excise Tax ct (GST)?... Yes No of an offence under the Taxation ct?... Yes No of an offence under the ct respecting the ministère du Revenu?... Yes No of an offence under the ct respecting the Québec sales tax (QST)?... Yes No of an offence under any other tax law?... Yes No pplication for a contr actor s licence - Natural person - Schedule 1 Page 11 of 12
1.1 s (if lender is a company or a partnership) Mr. Ms. ompany / partnership For the MMTQ s use only YER MONTH Y Home address in the case of a natural person, or civic address of headquarters, if company / partnership (P.O. box only is unacceptable) Number Street partment ity, village or municipality Province Postal code rea code Telephone number rea code Fax number rea code ell phone number l of an indictable offence?... Yes No of an offence under the Income Tax ct?... Yes No of an offence under the Excise Tax ct (GST)?... Yes No of an offence under the Taxation ct?... Yes No of an offence under the ct respecting the ministère du Revenu?... Yes No of an offence under the ct respecting the Québec sales tax (QST)?... Yes No of an offence under any other tax law?... Yes No 2 Signature and where the lender is a company or a partnership, I am authorized to sign on the lender s behalf. Last name First name ate Protection of personal information MMTQ a y consulted at the Régie s Web site, at www.rbq.gouv.qc.ca. The MMTQ may use this information for the administration and enforcement of the uilding ct. Only employees assigned to the enforcement of this ct shall have access to such information, to the extent that it is necessary for the performance of their duties. pplication for a contractor s licence - Natural person - Schedule 1 Page 12 of 12
roits et frais exigibles Grille de calcul (du 1er janvier au 31 décembre 2018) Type de demande Type de licence avant la demande Traitement prioritaire? 1 Type de licence après la demande roits Frais Non Total 1 Oui 1 Total 2 Général (annexe I) 738,38 $ 339,89 $ 1078,27 $ 1418,16 $ Nouvelle licence Général et spécialisé (annexes I, II et III) 738,38 $ 339,89 $ 1078,27 $ 1418,16 $ Spécialisé (annexes II et III) 369,18 $ 339,89 $ 709,07 $ 1048,96 $ Modification de licence impliquant un changement de catégorie d entrepreneur jout ou remplacement de sous-catégories Général (annexe I) ou Spécialisé (annexes II et III) Général et spécialisé 369,18 $ 339,89 $ 709,07 $ 1048,96 $ (annexes I, II et III) Spécialisé (annexes II et III) Général (annexe I) ou Échéance dans moins de 6 mois 2 Général et spécialisé (annexes I, II et III) 184,59 $ 2 339,89 $ 524,48 $ 864,37 $ Spécialisé (annexes II et III) ou Général (annexe I) Général et spécialisé 0 $ 339,89 $ 339,89 $ 679,78 $ (annexes I, II et III) Pas de changement de catégorie de licence (générale ou spécialisée) 0 $ 87,89 $ 87,89 $ 175,78 $ 1- Les frais exigibles sont portés au double si un traitement prioritaire est demandé. 2- Les droits sont réduits de moitié si la date d échéance annuelle de paiement pour le maintien de votre licence est dans moins de six mois. Pour les domaines dministration, Gestion de la sécurité et Gestion de projets et de chantiers, le coût indiqué s applique à chaque domaine demandé. Pour le domaine Exécution de travaux de construction, le coût indiqué s applique à chaque souscatégorie demandée. Pour les sous-catégories 1.4 à 1.7, consultez la page 3 pour les explications. N incluez pas les sous-catégories de l annexe III dans ce calcul, car elles ne nécessitent pas une évaluation des compétences et ne sont donc pas tarifées. 1 2 Type de demande Identifiez la situation correspondant à votre demande dans le tableau ci-dessus et inscrivez le total dans la case 1. Les situations non décrites danc ce tableau, comme le retrait de sous-catégories, ne sont pas tarifées. Inscrivez alors 0 dans la case 1. Évaluation de la qualification du répondant Inscrivez le nombre de domaines ou de sous-catégories à évaluer : a b c Par des examens Par la reconnaissance de la formation Sous-total Inscrivez le total dans la case 2. Par l évaluation du dossier professionnel Inscrivez le total dans la case 3. + = x = x = Répondant 87,89 $ Répondant 732,50 $ = = ase 1 ase 2 ase 3 3 Total de la demande dditionnez les montants des cases 1, 2 et 3 et inscrivez le total à la case 4. ase 4