Export of Substances on the Export Control List Regulations guidance document: notice of proposed export

Please download, fill, print and send back the PDF version of the above form. This HTML version is provided for on-line reading.

Part 1: general information

Exporter

Name of exporter: __________
Name of duly authorized representative: __________
Address: __________
Telephone number: __________
Fax number: __________
Email address: __________

Part 2: export notification

Cells have been left purposely empty to demonstrate which areas of the form need to be filled in.

Export notification
Name of the substance as it appears on the Export Control List Country of destination Expected date of export (yyyy-mm-dd) Estimated quantity of the substance to be exported (kg) Purpose of export
        [  ] Destruction
[  ] Industrial chemical use
[  ] Pesticidal use
[  ] Other use: _________
        [  ] Destruction
[  ] Industrial chemical use
[  ] Pesticidal use
[  ] Other use: _________
        [  ] Destruction
[  ] Industrial chemical use
[  ] Pesticidal use
[  ] Other use: _________
        [  ] Destruction
[  ] Industrial chemical use
[  ] Pesticidal use
[  ] Other use: _________

Are any of the above substances exported as “hazardous waste” or “hazardous recyclable material” under the Export and Import of Hazardous Waste and Hazardous Recyclable Material Regulations?
[  ] Yes  [  ] No
  If yes, please indicate which substance(s): __________

Part 3: exports subject to the Stockholm Convention for substances listed on part 2 or part 3 of the Export Control List

For all substances notified in part 2 of this form which are found on part 2 or part 3 of the Export Control List and listed in Annex A or B of the Stockholm Convention and in force for Canada, please complete the following:

Name of substance: ____________________

  1. Specific exemption or acceptable purpose applicable to the substance being exported (if applicable): _______

  2. Is the substance being exported for environmentally sound disposal in accordance with paragraph 1(d) of article 6 of the Stockholm Convention?
    [  ] Yes  [  ] No  
      If yes, please indicate:
        Facility name and civic address: _______________
        Method of disposal: _______________

  3. Is the substance being exported for use:
    1. in a laboratory for analysis? [  ] Yes  [  ] No
    2. in scientific research? [  ] Yes  [  ] No
    3. as a laboratory analytical standard? [  ] Yes  [  ] No

  4. Is the substance being exported contained in a product? [  ] Yes  [  ] No
      If yes,
    1. Is the substance incidentally present in trace amounts? [  ] Yes  [  ] No
    2. Was the product containing the substance manufactured on or before the coming into force for Canada of a provision of the Stockholm Convention prohibiting, under Annex A, or restricting under Annex B, the production or use of that substance? [  ] Yes  [  ] No
        If yes, indicate the date of manufacture of the product: _______________

(Repeat part 3 for each substance notified in part 2 of this form that is listed on Annex A or B of the Stockholm Convention and on part 2 or part 3 of the Export Control List)

Part 4: exports of asbestos listed on the Export Control List

For all forms of asbestos notified in part 2 of this form and listed on the Export Control List, please complete the following:

Name of substance: ____________________

  1. Is the substance being exported:
    1. contained in a product that is a personal or household effect intended for your personal use? [  ] Yes  [  ] No
    2. contained in a military equipment? [  ] Yes  [  ] No; or
    3. for disposal of the substance or of the product that contains it? [  ] Yes  [  ] No
        If yes, indicate:
          Facility name and civic address: _______________
          Method of disposal: _______________
    4. contained in a product that was used before December 30, 2018? [  ] Yes  [  ] No
    5. contained in a product that is exported in order to service military equipment, while that equipment is outside Canada for the purposes of a military operation and there is no technically or economically feasible asbestos-free alternative available? [  ] Yes  [  ] No
    6. contained in a product in not greater than trace amounts? [  ] Yes  [  ] No
    7. contained in a raw material that is extracted from the ground and this is exported:
      1. To manufacture a consumer product that contains asbestos in not greater than trace amounts? [  ] Yes  [  ] No
      2. To manufacture a product that is not a consumer product? [  ] Yes  [  ] No
      3. For a purpose other than manufacturing a product, if the material will not be sold as a consumer product? [  ] Yes  [  ] No
          If yes, please indicate (if known):
            Purpose of the export: _______________
    8. for use in a laboratory for analysis, in scientific research or as an analytical standard? [  ] Yes  [  ] No
    9. for display in a museum? [  ] Yes  [  ] No

(Repeat part 4 for each form of asbestos notified in part 2 of this form)

Attach supplementary sheets as necessary.

Send the notice by email, facsimile or by mail to:

Minister of the Environment and Climate Change
c/o Chemical Production Division
Environment and Climate Change Canada
351 Saint-Joseph Blvd 19th floor
Gatineau QC  K1A 0H3
Facsimile: 819-938-4218
Email: ec.substancedexportationcontrolee-exportcontrolledsubstance.ec@canada.ca

The regulations require notification to be provided at least 15 days (at least 7 days if the person holds a permit to export the substance issued under paragraph 185(1)(b) of the act) prior to the first export indicated on the notice. This form may be used to provide more than one notification under these regulations. Exporters are required to notify the minister of any corrections to the information provided in the notice within 30 days after learning of them.

Part 5: declaration

I declare that the information provided in this notice is accurate and complete. I understand that the information provided in this notice may be released to the country of destination.

_________________________________________________
Name of exporter or duly authorized representative (please print)

 

_________________________________________________
Title

_________________________________________________
Signature

 

_________________________________________________
Date and place

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