Trade in protected species: application for registration of scientific institution

CITES Form A5 (2014.02.04)

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Convention on international trade in endangered species of wild fauna and flora (CITES)

The scientific institution must meet the following conditions in order to be registered and to use a CITES Scientific Certificate:

Important Notes

CITES Permitting Office
Canadian Wildlife Service
Environment Canada
351 St-Joseph Blvd
Gatineau, Quebec K1A 0H3
Email : cites@ec.gc.ca
Fax: 1-855-869-8671

Section 1. Application type

Check one of the following:

New Application

Renewal of Scientific Registration

Number of the CITES registered
scientific institution:
_______________________________________________________
Expiry Date:
_______________________________________________________
Expected date of permit reception
(approximate if necessary):
_______________________________________________________
Year / Month / Day

I would like my permit sent by:

mailcourier (cost incurred by applicant)

If you would like your permit sent by courier, please provide:

Pre-paid envelope; or
Courier account number:
_______________________________________________________

Section 2. Name and address

Applicant (Canadian scientific institution)

Name of researcher:
_______________________________________________________
Title of researcher:
_______________________________________________________
Name of research supervisor or
sponsor:
_______________________________________________________
Name of the scientific institution:
_______________________________________________________
Street and number:
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Province/Territory:
_______________________________________________________
Postal Code:
_______________________________________________________
Country:
_______________________________________________________
Website:
_______________________________________________________
Email:
_______________________________________________________
Work Phone:
_______________________________________________________
Cell Phone:
_______________________________________________________
Fax:
_______________________________________________________

Section 3. Research and exchange of specimens

Description of research institution:

 

 

 

Description of research:
Attach a summary of the type of research done, including methodology.

 

 

 

 

 

Please check all that apply with respect to your institution:
□ collections of animal or plant specimens, and records ancillary to them, permanently housed and professionally curated
□ accessible to all qualified users, including those from other institutions
□ all accessions properly recorded in a permanent catalogue
□ permanent records maintained for loans and transfers to other institutions
□ specimens acquired primarily for purposes of research that is to be reported in scientific publications
□ specimens prepared and collections arranged in a manner that ensures their utility
□ accurate data maintained on specimen labels, permanent catalogues and other records
□ acquisition and possession of specimens accord with the federal/provincial/territorial laws in which the scientific institution is located
□ all specimens of species included in Appendix I to CITES permanently and centrally housed under the direct control of the scientific institution, and managed in a manner to preclude the use of such specimens for decoration, trophies or other purposes incompatible with the principles of the Convention

Expected number of shipments of the specimens to be exchanged within the next three years:

 

 

Section 4. CITES registered scientific institutions for exchange of specimens

Attach additional sheets if necessary.

Name of the scientific institution:
_______________________________________________________
CITES Registration Number:
_______________________________________________________
Street and number:
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Country:
_______________________________________________________
Postal Code:
_______________________________________________________
Name of the scientific institution:
_______________________________________________________
CITES Registration Number:
_______________________________________________________
Street and number:
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Country:
_______________________________________________________
Postal Code:
_______________________________________________________
Name of the scientific institution:
_______________________________________________________
CITES Registration Number:
_______________________________________________________
Street and number:
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Country:
_______________________________________________________
Postal Code:
_______________________________________________________
Name of the scientific institution:
_______________________________________________________
CITES Registration Number:
_______________________________________________________
Street and number:
_______________________________________________________
Post Office Box:
_______________________________________________________
City:
_______________________________________________________
Country:
_______________________________________________________
Postal Code:
_______________________________________________________

Section 5. Type of specimens

Identify the categories of specimens in which the institution is specialising and will be exchanging.
Attach additional sheets if necessary.

Type of Specimens
Category Classification of Specimen
(order, family, genus, or species)
Common Name Description
1 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

2 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

3 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

4 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

5 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

6 blank blank □ herbarium specimen
□ other preserved, dried or embedded museum specimen
□ live plant material
□ frozen museum specimen
□ other, specify:

Section 6. Origin and legality of CITES specimens

Describe the methods used by the institution to ensure that specimens in the collection to be exchanged were legally acquired:

 

 

 

 

Section 7. Current location of the specimen

Please check the appropriate box:

□ In Canada
□ Outside Canada
□ Detained by:
□ Canada Customs
□ Foreign Customs

Provide the Customs file number and copies of letters exchanged with Customs.

The undersigned hereby certifies that all information given in this application is true and correct.

Signature of applicant: _______________________________________________________
Date: _______________________________________________________
Year / Month / Day

Checklist
□ Did you sign the application?
□ Did you answer all relevant questions?
□ Did you attach copies of requested documents?

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