Trade in endangered species: application for re-export certificate

If you need assistance in completing this form, the 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:
__________________________________
  Expected date for the  reception of the CITES permit:
__________________________________

How should the CITES permit be sent to you?

□ Regular mail     □ Courier service 

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

Courier company name:
_______________________________________________________
Courier account number:
_______________________________________________________

Part 1: Contact information

1.1 Applicant information

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

To which address should the certificate be sent?

□ Applicant's address     □ Other address (please specify below) 

Address (number and street):
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Province/Territory/State:
_______________________________________________________
Country:
_______________________________________________________
Postal/Zip Code:
_______________________________________________________

1.2 - Broker information (if applicable)

Name:
_______________________________________________________
Name of business or organization (if applicable):
_______________________________________________________
Address (number and street):
_______________________________________________________
City:
_______________________________________________________
Province/Territory/State:
_______________________________________________________
Country:
_______________________________________________________
Postal/Zip Code:
_______________________________________________________
Email address:
_______________________________________________________
Daytime phone:
_______________________________________________________
Alternate Phone:
_______________________________________________________
Fax:
_______________________________________________________

1.3 - Consignee information

Name:
_______________________________________________________
Name of business or organization
(if applicable):
_______________________________________________________
Address (number and street):
_______________________________________________________
City:
_______________________________________________________
Province/Territory/State:
_______________________________________________________
Country:
_______________________________________________________
Postal/Zip Code:
_______________________________________________________
Email address:
_______________________________________________________
Daytime phone::
_______________________________________________________
Alternate Phone:
_______________________________________________________
Fax:
_______________________________________________________

Part 2: Reason for re-export

Are the specimens being sent in order to be sold in the country of import?

□ Yes     □ No 

Is this shipment being sent for an education program in the country of import?
Supporting documentation must be provided with details on the program.

□ Yes     □ No 

Is this shipment being sent for an exhibition in the country of import?

□ Yes     □ No 

Please specify the name of the exhibition:

_______________________________________________________

Will the specimens be introduced or re-introduced into the wild?
Supporting documentation must be provided with details on the program.

□ Yes     □ No 

Is this shipment being sent to a zoo or refuge?

□ Yes     □ No 

Is this shipment being sent for scientific analysis or research in the country of import?
Supporting documentation must be provided with details on the scientific project or research.

□ Yes     □ No 

Is there breeding planned for the specimens in the shipment?

□ Yes     □ No 

Part 3: Item(s) and shipments

3.1 Specimen inventory

Specimen Inventory
Item number Item Description: Species Scientific Name
Quantity for Country of Origin

CITES Permit number:
Country of Origin

Permit issue date:
(DD-MMM-YYYY)
Country of Last Re-export

CITES Certificate number:
Country of Last Re-export

Permit issue date:
(DD-MMM-YYYY)
1 blank blank blank blank blank blank blank
2 blank blank blank blank blank blank blank
3 blank blank blank blank blank blank blank
4 blank blank blank blank blank blank blank
5 blank blank blank blank blank blank blank

3.2 Shipments (for multiple shipment re-exports only)

Specify the number of shipments that will occur in the next 6 months for these specimens:

_______________________________________________________

Part 4: Transport information (for live animals only)

Specify the number of shipments that will occur in the next 6 months for these specimens:

□ By air      □ By Sea     □ Over land 

_______________________________________________________

Part 5: Current location of the specimen

In which country is the specimen located?

_______________________________________________________

If the animal(s) is detained, please indicate where it is detained.

□ Canada Customs
□ Foreign Customs

Provide the Customs file number as well as all copies of the documents pertaining to the detention:

_______________________________________________________

□ 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)
_______________________________________________________
Date (dd/mm/yyyy):
_______________________________________________________

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