ARCHIVED - Authorization for a Third Party to Import a Natural Health Product for a Clinical Trial Form

This content was archived on June 24 2013.

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For Viewing Purposes Only - Licence applicants must use the available WORD or PDF versions of this form when submitting it to the Natural Health Products Directorate (NHPD).

(ARCHIVED - PDF Version - 90 K)

(Word Version - 44 K)

Template Authorization for a Third Party to Import the NHP

I, __________________ authorize __________________ (list each applicable importer, add more space as necessary) to import the NHP for the purposes of the clinical trial described within this application.

Signed:     
Print name:     
Title:     
Clinical Trial Sponsor:     
Date:     


Submit with application only if the clinical trial sponsor is located outside of Canada and is authorizing one or more third parties to import the NHP for the purposes of the clinical trial described within this application. A separate authorization is required for each clinical trial application. As additional importers are identified, additional copies of this document should be provided to Health Canada. If the importer has not changed when a clinical trial application amendment is filed, this document does not need to be re-submitted.

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