I hereby make application under the Engineers and Geoscientists Act, 2008 to be registered/enrolled in Newfoundland and Labrador.

I declare that all of the above statements are complete and correct to the best of my knowledge and belief.

I understand that a false statement or failure to provide the information requested may, at any time, disqualify me from registration. I authorize PEGNL to obtain such additional information as it may deem appropriate, from such additional sources as it may deem appropriate for the processing of my application.

If granted registration or a license, I hereby agree to abide by the terms of the Act, Regulations, By-Laws and Code of Ethics of Professional Engineers and Geoscientists of Newfoundland and Labrador.

I also declare that I have read and understand all supplemental information included in this form (Language Requirements, and Competency-Based Assessments), and that I may be asked to supply additional documents or details as part of the application process.