Request for Examination Deferment Request for Examination Deferment Please note only one request for deferment is allowed per application. If the deferred date is missed. The applicant must reapply including all fees and resubmitting all documents. Name* Home Address* City* Province Postal Code Phone* Email* Date of Examination* Next examination date requested* Reason for deferment.* Admin fee for deferment* PayPal ($75.00 + Tax) Application Declaration: I hereby verify that the information submitted for this application accurately documents my request without impinging on my right to Privacy. I understand that providing false information will result in immediate withdrawal of my application and could result in disciplinary action. I hereby declare that the information given in this application is, to the best of my knowledge, true, correct, and complete in every aspect and that I am the applicant.* By clicking here you accept the Application Declaration and all information provided to be true.