Notification Form / Conditions for Provision of Packaging/Labelling Services for Drugs under Foreign Ownership (GUIDE-0067)

(May 1st, 2004)

Contact: Drugs GMP Inspection Unit
Tel: (613) 957-1492
Fax: (613) 952-9805
E-Mail: GMP_questions_BPF@hc-sc.gc.ca

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Notification Form

Part 1 - Notification to Health Canada prior to shipment to Canada

Contract packager-labeller

Name:
Address:
City:
Postal Code:
Telephone:
Fax :

Drug to be packaged/labelled

Name (active ingredient):
Brand name:
Quantity:
Manufacture date

Foreign fabricator

Name:
Address:
City:
Country:

Expected date of entry into Canada

Port of entry in Canada

Expected date of return to the fabricator

Part 2 - Notification to Health Canada after the return of the drug to the foreign owner

Quantity packaged

Type and format of packaging material

Quantity of drug per packaging unit

Number of units packaged

Quantity of packaged units returned to the fabricator

Date of return

Transport Mode

If discrepancies, please explain:

Signature :

Page details

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