Application for Certificate Respecting Corporate Name

Application for Certificate Respecting Corporate Name
Name of MVMA member intending to practice veterinary medicine on behalf of the intended corporation (the “Applicant”):*

First NameLast Name
Mailing address of the Applicant:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's phone number*
Please enter a valid phone number.
Applicant's fax number
Please enter a valid fax number.
Applicant's email address*
Correspondence and the Name Consent will be emailed to this email address
1. I confirm that I am a licensed member in good standing of the Manitoba Veterinary Medical Association.*

Yes
2. I confirm that I intend to practice veterinary medicine on behalf of a veterinary corporation.*

Yes
3. I hereby apply for a certificate that Manitoba Veterinary Medical Association consents to the intended corporation having the following name:*
4. I attach a business name reservation, showing that the Manitoba Companies Office has reserved the Intended Name at my request.*

Attach Manitoba Companies Office business name reservation
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Optional Attachment
If the applicant's legal representative is completing this form, you must attach documentation in which the applicant attests that 1) the information contained in this application is correct and 2) the applicant consents to the legal representative completing the Application for Certificate Respecting Corporate Name on his or her behalf.

Cancelof
I understand that, if the Manitoba Veterinary Medical Association issues a certificate by reason of this application, the certificate would state only that the Manitoba Veterinary Medical Association consents to the proposed name for your veterinary corporation. The certificate would not reserve the name, and it would not imply that the Manitoba Companies Office has approved the name.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Application for Certificate Respecting Corporate Name

Optional Attachment