COPE Identification Statement

Print out form, fill in information and attach photos. Mail in Section A. Keep Section B to bring to the Test.

Section A (for COPE Testing Ltd.)

Family name: Given names:
Date of Birth:                                 /               /               / (YYYY/MM/DD) year / month / day
Date of Test: Signature of Candidate:
Home Phone Number: Email:
If you wish to use a credit card, please fill in your details here: VISA []   MASTERCARD [] Number  __________________________________

Expiry date _______________________                Amount paid ____________________
The following declaration must be made by a Canadian citizen who has professional status (e.g.teacher, principal, doctor, lawyer, manager) and who is not a relative.
I,                                                    certify that this photograph is a true likeness of 
          (name of witness above)
(name of candidate above)

 

Signature of witness (please sign across photograph): 
 

Profession                                     Business Telephone
 
 
 
 

 
 

Affix passport size 
photo here


















 

Section B (bring to the test with you)

Family name:
Affix passport size
photo here

 
Given names:
Signature of Candidate:
Date of Birth:                                /               /             /

 

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