Training Verification Online Payment Form

Training Verification Online Payment Form

Please read the instructions below carefully prior to completing the accompanying form.
INSTRUCTIONS

Before sending payments, please send all inquiries and requests to the Training Verification Officer (trainingverification.medicine@utoronto.ca). The Training Verification Officer will first confirm the trainee was in fact with the Department of Medicine, University of Toronto, and will then determine the verification needed and costs associated with the requests.

Training verification will not be processed until payment has been received and authorization of release of information has been signed by the trainee and received by the Department of Medicine.

Important Notes:
- Processing Time: Upon receipt of all the necessary information, consent and payment, training verification will be finalized within 10 business days should there be no concerns. Processing could be delayed if there is a conflict in the current state of the resource we have stored in our Department of Medicine.
- Refund Policy: In the event we are unable to complete the verification of training, the full refund will be issued as a cheque that will be mailed out, which may take up to 6-8 weeks. Otherwise, all payments are final and no refund will be issued.
For detailed information, please refer to the Department of Medicine Training Verification.
Statement of Obligation
By proceeding to complete the Training Verification Online Payment Form, I hereby agree to the following:*

I acknowledge I have carefully read and fully understand the contents of the aforementioned Instructions AND the hyperlinked Department of Medicine Training VerificationI acknowledge I have contacted the Training Verification Officer and they have confirmed with me that the person whose credentials are being verified was in fact registered with the Department of Medicine, University of Toronto, and has directed me to this website to proceed with the Training Verification Online Payment Form

Shipping Mailing Address Information
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Online Payment Information
Total amount of payment will be (Canadian dollars):
Billing address same as shipping address?*

YesNo
Company Name (if applicable)
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Credit Card Details*

CADTotal amount of payment (Canadian dollars)

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

The Department of Medicine has partnered with Moneris (service provider) to provide clients with an online credit card fee payment option.

The online Mastercard and Visa Canadian Dollar verification fee payment service is inclusive of a convenience fee collected directly by Moneris.
Acknowledgement
By signing below, I declare that the information I have given in this form is accurate and true, and I acknowledge that my payment and order is final.
Signature*

Clear
Date signed*

YearMonthDay
Date
Freedom of Information and Protection of Privacy: The University of Toronto is committed to the protection of privacy. Ontario universities are covered by the Freedom of Information and Protection of Privacy Act (the Act) which supports access to University records and protection of privacy. The University upholds these principles. For detailed information and its application, please visit https://www.utoronto.ca/privacy.
Should be Empty:

Training Verification Online Payment Form

Statement of Obligation

Requesting Institution/Person’s Contact Information

Physician's Personal Information

Training Verification Request Type

Delivery Options

Shipping Mailing Address Information

Online Payment Information

Acknowledgement