Application to export biomedical samples

If you need assistance in completing this form, the Convention on International Trade in Endangered Species (CITES) Management Authority Office can be contacted by email or by telephone at 1-855-869-8670.

Important Instructions for the Applicant
Please read carefully - Be sure to fill-in all related questions on the application form. An incomplete application may cause delays in processing.

Type of application

New Application

Replacement

Reason for replacement:
____________________________________
Number of the CITES permit being replaced:
____________________________________

How should the CITES permit be sent to you?

Regular mailCourier service

For the permit to be sent by courier, indicate the courier company name and your account number:

Courier company name:
_______________________________________________________
Courier company name:
_______________________________________________________

Part 1: Mailing information

Name:
_______________________________________________________
Name of business or organization
(if applicable):
_______________________________________________________
Address (number and street):
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Province/Territory:
_______________________________________________________
Postal Code:
_______________________________________________________
Daytime phone:
_______________________________________________________
Alternate phone:
_______________________________________________________

Part 2: Request for copies

CITES permit or certificate #:

_______________________________________________________

For the permit to be sent by courier, indicate the courier company name and your account number:

Date of issue: (DD-MMM-YYYY) _______________________________________________________
Valid until: (DD-MMM-YYYY) _______________________________________________________

Number of copies requested:

_______________________________________________________

Rationale for additional copies request:

_______________________________________________________

□ I understand that it is my responsibility to be informed of all other requirements with regard to possession, care and transport of my animal(s) and have or will obtain any additional authorizations or permits required by other jurisdictions, federal government agencies, or foreign countries.

I hereby certify that I am authorized to submit this application and that the information submitted is complete and accurate to the best of my knowledge.

(sign with dark ink)
____________________________________
(dd/mm/yyyy)
____________________________________

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