Application Request Form

Personal Information

LAST OR FAMILY NAME: DE GUZMAN

FIRST NAME: ROGEL

MIDDLE NAME(S): MARCELO

Mailing Address Contact Information

BLK 539 ANG MO KIO AVENUE 10 MAIN PHONE: 6596399755
#05-2575
ALTERNATE PHONE:
SINGAPORE, Central Singapore
Singapore EMAIL ADDRESS: ROGELDEGUZMAN@GMAIL.COM
560539

Additional Personal Information

BIRTHDATE: 03/20/1985

COUNTRY OF BIRTH: Philippines

GENDER: Male

LAST COUNTRY OF EDUCATION: Philippines

PREVIOUSLY APPLIED: No

IQAS FILE NUMBER: 258596

DO YOU WANT TO RECEIVE INFORMATION ABOUT WORKING AND LIVING IN ALBERTA?: No

HAVE YOU REQUESTED ORIGINAL DOCUMENTS FOR YOUR CREDENTIALS BE SENT DIRECTLY TO IQAS?: No

Reason for Assessment

X To support my ECA application for immigration purposes

Mailing Address: International Qualifications Assessment Service (IQAS)

1 of 5
9th Floor, 108 Street Building, 9942-108 Street, Edmonton, Alberta, Canada, T5K 2J5
 Application Request Form

Educational History

NAME OF INSTITUTION: Polytechnic University of the Philippines COUNTRY: Philippines

NAME OF CERTIFICATE/
DIPLOMA/ DEGREE: BACHELOR IN BANKING AND FINANCE ATTENDANCE DATES: 2001 - 2005

Assessment(s) Fees
ECA Assessment ECA Assessment: $200 (1 @ $200/each)

Courier Fee
Delivery of your Certificates : $75

TOTAL FEE: $275

Transaction Information

Payment Method: Online Payment (Visa, MasterCard, American Express, Visa Debit, or Interac) , Transaction Id -
200546989

Mailing Address: International Qualifications Assessment Service (IQAS)

2 of 5
9th Floor, 108 Street Building, 9942-108 Street, Edmonton, Alberta, Canada, T5K 2J5
 Application Request Form

Declaration

(Please read carefully and SIGN)

I authorize the International Qualifications Assessment Service (IQAS) to carry out the procedures necessary for the evaluation of
my file. This includes making and retaining copies of my records for the purpose of assessment and/or contacting such education
and government institutions and agencies as IQAS deems necessary to evaluate my credentials.

I understand the assessment of my qualifications may be useful for employment or application to some post-secondary institutions
but it does not guarantee employment, entrance to a profession or a post-secondary institution.

I understand that an ECA (also referred to as an assessment for immigration purposes) may be used for application to
Immigration, Refugees and Citizenship Canada, but that it does not guarantee the success of my application for immigration. I
further understand that if I submit my IQAS ECA to Immigration, Refugees and Citizenship Canada, IQAS will share my personal
information, information about my academic credentials and the results of my IQAS assessment with Immigration, Refugees and
Citizenship Canada.

I declare that all of the information and documentation is complete and that these documents have not been changed or altered in
any way. In the event that IQAS determines that an educational document submitted for an evaluation has been altered, tampered
or forged, IQAS will immediately cancel the assessment. IQAS will not issue a refund and will retain all educational documents
submitted with the assessment request. IQAS reserves the right to share information on altered, tampered or forged documents
with academic institutions, government agencies and other evaluation services.

I hereby authorize and consent to the release of any or all information, documents or records which are in the possession of IQAS
to all institutions / organizations that I have listed on this form.

I further release IQAS from any liability resulting from the use of my assessment. I have read and understand the above and the
information on this form and agree to the terms stated herein.

Information you provide to Alberta Labour is collected under the authority of Section 33(c) of the Freedom of Information and
Protection of Privacy (FOIP) Act and is managed in accordance with Part 2 of the FOIP Act. Your personal information is collected
for the purpose of assessing your educational documents and qualifications by the Government of Alberta for the International
Qualifications Assessment Service (IQAS). Your personal information may be used to contact you for survey participation in the
evaluation of the IQAS program. Your information will not be used or disclosed for any other purpose by Alberta Labour without
your consent or unless required to do so by law. Should you wish to have your personal information removed, corrected or have
concerns pertaining to the IQAS application form, please contact the Director, International Qualifications Assessment Service at
780-427-2655.

Date signed (yyyy/mm/dd) Signature

Mailing Address: International Qualifications Assessment Service (IQAS)

3 of 5
9th Floor, 108 Street Building, 9942-108 Street, Edmonton, Alberta, Canada, T5K 2J5
 Immigration Assessment Document Checklist
Please complete the checklist below to ensure your application is ready for payment and submission.

Identification Documents
Identification Condition Instructions Method
Documents

Proof of Name Must Have A photocopy of government issued identity document. For Mailed
example, a passport or drivers license. Does not have to
X Uploaded
be certified/notarized.

Proof of Name Conditional If your name is different from the name on your educational Mailed
Change documents. For example, a photocopy of a marriage
Uploaded
certificate or official name change document. Does not
have to be certified/notarized.

Educational Documents

BACHELOR IN BANKING AND FINANCE

Educational Condition Instructions Method

Documents

Degree/ Diploma/ Must Have Photocopy of the degree or diploma with the name in the Mailed
Certificate original language for each degree reported.
X Uploaded

Translations of all Conditional If your documents were not originally issued in English. An Mailed
educational official translation of your degree/ diploma and transcripts,
Uploaded
documents mark sheets or grade reports.Does not have to be
certified/notarized.

Transcripts, Mark Must Have Transcripts, mark sheets, or grade reports sent to IQAS
Sheets, or Grade from each Issuing Body reported in this application.
Reports

Mailing Address: International Qualifications Assessment Service (IQAS)

4 of 5
9th Floor, 108 Street Building, 9942-108 Street, Edmonton, Alberta, Canada, T5K 2J5
Additional Information:

Mailing Address: International Qualifications Assessment Service (IQAS)

5 of 5
9th Floor, 108 Street Building, 9942-108 Street, Edmonton, Alberta, Canada, T5K 2J5