Application for Export Permit for Controlled Substance or Precursors

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Under the provisions of the Controlled Drugs and Substances Act and its Regulations

Application type

  • Controlled Substance or Precursor Class A/B
  • Shipment purpose

Applicant (exporter)

  • Company Name
  • Licence or Registration Number
  • Address
  • Business Number

Customer (importer)

  • Company Name
  • Address

Proposed customs broker (if any)

  • Name
  • Address

Shipment

  • Proposed port of exit
  • Proposed means of transport
    • Highway
    • Air
    • Marine
    • Rail
  • Proposed date of export from Canada
  • Name of the proposed carrier
  • Name of any proposed country of transit or transhipment

Controlled substance or precursor to be shipped (one product per application)

*as stated on the licence
**Please include packaging information for pharmaceutical formulations

  • Product Name
  • Quantity**
  • Name of Controlled Substance or Precursor*
  • Total Quantity of Controlled Substance or Class A Precursor
  • Chemical Abstracts Service (CAS) Number (if any)
  • Drug Identification Number (DIN)/Natural Product Number (NPN) (if any)

Certification

I hereby attest that the information provided in support of this application is, to the best of my knowledge, correct and complete.

I hereby consent to the disclosure of information contained in this application to the International Narcotics Control Board and the competent authority in the country of import for the purpose of verifying the information.

  • Name of RPIC, A/RPIC or QPIC, A/QPIC
  • Signature
  • Date

For official use only

  • Permit Number
  • Input by
  • Date
  • Permits Officer Comments
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