Form 41 - Certificate Of Permission To Act Renewal Application & Declaration Page 2

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4.
Fees
I confirm that my Certificate of Permission to Act in the Yukon fees are attached:
Annual Renewal Fee of $350
Yes
No
Special Fund Levy of $100
Yes
No
GST
Yes
No
Exemption from Special Fund Levy
I undertake that I have read Sections 45, 47 and 49 of the Legal Profession Act and understand the
requirements and provisions of the Special Fund. I am exempt from paying the Special Fund Levy for the
following reason:
No property that belongs to another person will be entrusted to or received by me in my capacity
as a barrister or solicitor.
AND/OR
I am a public officer or a member of the public service.
I undertake that should the above-noted situation change, I will immediately notify the Law Society of
Yukon and make immediate remittance to the Law Society of Yukon of the Special Fund Levy.
5.
Professional Liability Insurance
As of the date of this application there is in place a policy of professional liability
insurance in respect of my practice of law in the Yukon Territory
OR
I qualify for exemption from the requirement for professional liability insurance.
6.
Certificate of Standing
I am not aware of any new professional complaints, discipline matters or criminal charges
arising since the date I first made application for this Certificate of Permission to Act;
OR
I am aware of a new professional complaint, discipline matter or criminal charge arising since the
date I first made application for this Certificate of Permission to Act in the Yukon.
Please provide the details, including dates.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
DECLARATION
I solemnly declare that the statements made in this Application are true.
Sworn before me at the _________ of _______________)
in the Province/Territory of _______________________ )
this _____ day of _______________________, 200___. )
)
)
)
_____________________________________________ )
_______________________________
Notary Public or Commissioner for taking Oaths in and )
Signature
for the Province/Territory of _____________________. )
Form 41
Page 2 of 2

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