1243 Islington Avenue, Suite 501
Toronto, Ontario M8X 1Y9
P : 416 234 8800 | F : 416 234 8820
www.alliancept.org
Form C – Educational Credential and Qualifications Assessment
Declaration of Identity Form – Instructions
Identity Document(s)
We need one (or more) official document(s) that have the following:
•
your photo
•
your full legal name
•
your date of birth
•
your signature
If all the information we need is on one document, you do not need to submit more than one document.
You must make sure that your identity document:
•
is official (i.e., issued by the government / agency authorized by the government to issue official documents),
•
is valid (it is not expired), and
•
can be verified with the source.
We do not accept original documents. Please submit a copy of your identity document(s).
Here is a list of documents you can submit to support your identity:
a. Birth Certificate (Attach a certified translation if your Birth Certificate is in a language other than English or French.)
b. Passport (We do not need all the pages in your passport. We only need the pages with the required information.
For example, if your photo, full legal name and your date of birth is on one page and your signature is on another page, we will need both pages.)
c. Canadian Citizenship Card
d. Health Card from a Canadian province or territory
e. Driving Permit (Driver’s Licence) from a Canadian province or territory (If some of the required information is on
the back of the card, send us a copy of both sides.)
f. Identification Card from a Canadian province or territory (If some of the required information is on the back of the
card, send us a copy of both sides.)
g. Canadian Immigration Record of Landing
h. Canadian Permanent Resident Card
i. Refugee Protection Claimant Document
If you do not have an official document...
If you do not have an official document, you, personally, must sign an affidavit that is certified by a notary public.
The affidavit must state:
•
that the name shown on your application is your full legal name
•
your date of birth
•
the reason why you don’t have an official document.
You must still complete the Declaration of Identity Form in front of a notary public, have it notarized and send it to
our office with your affidavit.
1243 Islington Avenue, Suite 501
Toronto, Ontario M8X 1Y9
P : 416 234 8800 | F : 416 234 8820
www.alliancept.org
If you have changed your name...
If you have changed your name, you must send one of the following documents certified as a true copy of the original
by a notary public with a certified translation attached if the document is in a language other than English or French:
•
Marriage Certificate
•
Legal change of name document if you have legally changed your name.
This is only necessary if any of your required documents (academic records, degrees, other documents)
are in a different name from the name on your application.
Photographs - hardcopy requirements
You must provide two (2) identical colour passport photographs.
The photographs must be:
a. Current - taken within the past six (6) months,
b.Colour,
c. Passport size and quality - full-face and very clear, and
d.Original (not taken from an existing photo).
You must attach ONE photograph firmly to the Declaration of Identity Form in the designated space and have
it officially certified by a notary public. The stamp or seal of the notary public must appear partly on the photograph
and partly on the Declaration of Identity Form.
On the back of the second photograph, you must print your name, print the date the photograph was taken and sign.
NOTE
•
The Declaration of Identity Form will be valid for 5 years and will be shared with the Exam department when you
become eligible for the Physiotherapy Competency Examination (PCE). Your Declaration of Identity Form must
still be valid when you attempt an administration of the PCE.
•
Many applicants do not print their full legal name on the Application form or on the top section of the
Declaration of Identity Form (or on other forms) but print their full legal name in the Section 1 of the Declaration
of Identity Form. We need your full legal name on all the forms that you will complete and send to us.
The following example may help applicants when completing the various forms:
Example:
If your full legal name is “Mary Jane Smith”, then print Mary Jane Smith on the following forms:
1.Application form;
2.top section of the Declaration of Identity form;
3.the first page of the Document Request Form before you send it to your school;
4.Application Checklist;
5.Section 1 of the Declaration of Identity form.
Make sure that the identity document (e.g., passport, driver’s Licence etc.) you submit with your Declaration
of Identity has your full legal name “Mary Jane Smith”.
1243 Islington Avenue, Suite 501
Toronto, Ontario M8X 1Y9
P : 416 234 8800 | F : 416 234 8820
www.alliancept.org
FORM C - DECLARATION OF IDENTITY
I,
, declare that I am the person named on this document and the
photograph attached to this document is my photograph.
Section 1 – Applicant
Stamp or seal of the Notary
Public must cover a portion
of the attached photograph
and a portion of this form.
Photo
By signing the Section 1 of the Declaration of Identity document you certify that the photograph attached herein is your photograph which was taken within the past six (6) months.
Full Legal Name of Applicant (Print):
Last Name(s)/Surname(s):
First Name(s)/Given Name(s):
Middle Name(s):
Date of Birth of Applicant: Day: Month: Year: Signature of Applicant:
Section 2 – Notary Public
Stamp or seal
of Notary Public
I certify that I have checked the identity document(s) and I have verified the identity and the legal name of this person and that this person has signed before me on:
Day: Month: Year: At:
Name:
Signature:
Address:
Telephone:
Email:
The Notary Public’s contact information is required to allow us to verify the applicant’s information, if necessary
A Notary Public must officially certify this document.