Information Provider Profile Form for Initial Electronic Pesticide Regulatory System (e-PRS) Enrolment

This form must be completed and must accompany every Primary Officer request for initial Electronic Pesticide Regulatory System Secure Web Portal (e-PRS SWP) enrolment submitted to the Pest Management Regulatory Agency (PMRA).

A Primary Officer wishing to make changes to an established Information Provider Profile should contact the PMRA to discuss the changes and to seek advice as to what documentation will be required to be submitted to support the change request.

Please note: Steps 1 to 4 must be completed.

Step 1

Step 2

• Mailing Address:
• City/Town:
• Province/State:
• Country:
• Postal Code/ZIP:

• Name:
• Title:
• Phone:
• Fax:
• E-mail:
• Signature of Primary Officer:

Step 3

Please provide the answers to all 4 of the shared secrets below. Remember your answers as they will be required to activate your e-PRS SWP account, when we send you your activation key.

• What is your favourite type of food?
• What is your favourite type of drink?
• What is your favourite colour?
• What is your favourite sport?

Step 4

Please indicate with an "X" all of the roles that apply to this Information Provider:

All information providers who indicated in Step 4 that they hold or intend to hold registrations (e.g., applicant/registrant) must complete the rest of the form.

Step 5

• Same info as step 2

• Mailing Address:
• City/Town:
• Province/State:
• Country:
• Postal Code/ZIP:

• Name:
• Title:
• Phone:
• Fax:
• E-mail:

Step 6

• Same info as step 2 or
• Same info as step 5

• Business Name (Full name - no abbreviations):
• Mailing Address:
• City/Town:
• Province:
• Canada
• Postal Code:

• Name:
• Title:
• Phone:
• Fax:
• E-mail:

If you require assistance in completing this form or with any other aspects of preparing the enrolment request, please contact the Pest Management Information Service.