The following declaration should be signed either by the Applicant or the person responsible for the Applicant: I hereby certify that the Applicant named herein is normally a resident in Canada. I and/or the Applicant have read the “General Terms and Conditions” as published on the web site included in the “International Medical Consulting” (as therein defined) which I agree to incorporate into this document by reference, and to which I acknowledge that I am bound. I further certify that information given in this application and in any appended documents (i.e. proof of legal name change) is both correct and complete.