Certification Statements
I hereby certify that all the information given in this application is true and accurate and that the photographs enclosed are
recent photographs of myself (within twelve months).
I understand that falsification of this application, submission of falsified documents to The Pharmacy Examining Board
of Canada, (hereinafter referred to as "the Board"), submission of falsified Board documents to other agencies, giving or
receiving of assistance in answering test-items during the examination, access to test-items before or after the examina-
tion, reproduction of examination content in any manner, and/or disclosure of test-items to others, or a violation of law as
stated in the Pharmacy Examining Board of Canada By-Laws, Sections 20.4 and 20.5 may be sufficient cause for the
Board to bar me from the examination, to terminate my participation in the examination, to invalidate the results of the
examination, to withhold my results, to bar me from future examinations, to remove my name from the Register or to take
appropriate action as it sees fit, including cost recovery for all damages. If any of the events previously mentioned in this
paragraph occur, I understand that any document giving the results of my examination which has been issued by the
Board will be invalid and that it will be returned by me to the Board forthwith, on demand.
I will conduct myself in a professional manner when interacting with the Board and examination staff before, during and
after the examination.
If any document giving the results of my examination has been issued otherwise in error, I understand that the docu-
ment is invalid and that I will return such document to the Board forthwith, on demand.
I understand that my results will be given on a pass or fail basis only.
I also understand that the accompanying fee cannot be refunded, except under special circumstances defined by the
Board.
I hereby authorize the Board to divulge any information contained in this application, or information flowing from the
result