Application for Import Permit for Controlled Substance or Class A Precursor

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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
  • Importation purpose

Applicant (importer)

  • Company Name
  • Licence Number
  • Address
  • Business Number

Supplier (exporter)

  • Name
  • Address

Proposed customs broker (if any)

  • Name
  • Address

Shipment

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

Controlled substance or class a precursor to be imported (one product per application)

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

  • Product Name
  • Quantity**
  • Name of Controlled Substance or Class A 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)

Attestation

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 export for the purpose of verifying this information.

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

For office use only

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