2022 Veterinary Corporation Permit Renewal Form
I am completing this declaration in regard to the following Veterinary Corporation:
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* Please note that an Officer of the Veterinary Corporation must complete this form.
DECLARATIONS
1. Please choose 1 option:
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I intend to renew the Veterinary Corporation Permit set to expire on June 30, 2022
I DO NOT intend to renew the Veterinary Corporation Permit set to expire on June 30, 2022. The Corporation has been dissolved. I understand that I must provide documentation confirming same to the MVMA via email or regular mail.
2. Please choose 1 option:
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I declare that I have reviewed the most recent “Corporation Particulars” sent for the above-named corporation with the 2022 Veterinary Corporation Permit Renewal information and that the information contained therein continues to be complete and accurate.
I declare that I have reviewed the most recent “Corporation Particulars” sent for the above-named corporation with the 2022 Veterinary Corporation Permit Renewal information and that the information contained therein has changed or is not correct. I understand that I must provide a Change in Particulars Form, which indicates changes and/or inaccuracies (this form can be obtained on the MVMA website at https://www.mvma.ca/veterinarians-corporations/ ) to complete the renewal application.
3. Please choose 1 option:
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I declare that no Articles of Amendment or Articles of Amalgamation, etc, since the most recent Veterinary Corporation Permit was issued.
I declare that there have been Articles of Amendment or Articles of Amalgamation, etc, since the most recent Veterinary Corporation Permit was issued. I understand that I must provide copies to the MVMA via email or regular mail to complete the renewal application.
4. Please confirm:
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I understand that the MVMA will directly request information about the Veterinary Corporation from the Manitoba Companies Office.
5. Please confirm:
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I understand that pursuant to MVMA General By-Law No. 1 that I must notify the registrar in writing within 15 days of any changes to the Veterinary Corporation. (The MVMA’s Change in Particulars Form can be located on the MVMA’s website at https://www.mvma.ca/veterinarians-corporations/ )
6. The Veterinary Corporation provides veterinary medical services at the following PIPS inspected practice(s)/clinic(s):
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7. Please confirm:
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I understand that the provision of false information in any part of this document is professional misconduct. I hereby certify that all of the information contained herein is true, correct and complete.
DIGITAL SIGNATURE
Name of Officer of the Corporation completing this form:
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Email address
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A copy of your submission will be sent to this address.
Date of Renewal Application (please indicate today's date)
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Month
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Day
Year
Signature of the Officer of the Corporation:
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Clear
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 Veterinary Corporation Permit Renewal on his or her behalf.
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PAYMENT INFORMATION
Please choose 1 option:
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I will pay the Veterinary Corporation Permit fee of $78.75 ($75.00 + GST ) by credit card below.
I will send a cheque in the amount of $78.75
My Products (only select this option if paying by credit card)
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Veterinary Corporation Permit
2021-2022 Veterinary Corporation Permit ($75.00 + GST)
$
78.75
CAD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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