This page has been archived on the Web

Information identified as archived is provided for reference, research or recordkeeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please contact us to request a format other than those available.

Skip booklet index and go to page content

Guidance document for Export of Substances on the Export Control List Regulations

Forms for exporters - Notice of export

Part 1: General information

Exporter
Name of exporter:
Name of duly authorized representative:
Address:
Telephone number:
Fax number:
Email address:

For Environment Canada use


Part 2: Export notification

Export notification
Name of the substance as it appears on the Export Control List (Schedule 3 of the Canadian Environmental Protection Act, 1999)Country of destinationExpected date of exportEstimated quantity of the substance to be exported (kg)Purpose of Export
    [  ] Destruction
[  ] Industrial Chemical use
[  ] Pesticidal use
[  ] Other use
    [  ] Destruction
[  ] Industrial Chemical use
[  ] Pesticidal use
[  ] Other use
    [  ] Destruction
[  ] Industrial Chemical use
[  ] Pesticidal use
[  ] Other use
    [  ] Destruction
[  ] Industrial Chemical use
[  ] Pesticidal use
[  ] Other use

 

Are any of the above substances classified as “hazardous waste” or “hazardous recyclable material” under the Export and Import of Hazardous Waste and Hazardous Recyclable Material Regulations?

[  ] Yes  [  ] No

If yes, please indicate which substance(s): __________


Part 3: Exports subject to the Stockholm Convention for substances listed on Part 2 or Part 3 of the Export Control List

For all substances notified in Part 2 of this form which are found on Part 2 or Part 3 of the Export Control List and listed in Annex A or B of the Stockholm Convention, please complete the following:

Name of Substance: ____________________

  1. Specific exemption or acceptable purpose applicable to the substance being exported (if applicable): _______

  2. Is the substance being exported for environmentally sound disposal in accordance with paragraph 1(d) of Article 6 of the Stockholm Convention?
      [  ] Yes  [  ] No  If yes, please indicate:
        Facility: _______________
        Method of disposal: _______________

  3. Is the substance being exported for use:
    1. in a laboratory for analysis [  ] Yes  [  ] No
    2. in scientific research [  ] Yes  [  ] No; or
    3. as a laboratory analytical standard? [  ] Yes  [  ] No
  4. Is the substance being exported contained in a manufactured article? [  ] Yes  [  ] No
    If yes,
    1. Is the substance incidentally present in trace amounts? [  ] Yes  [  ] No
    2. Was the article containing the substance manufactured on or before the coming into force for Canada of a provision of the Stockholm Convention prohibiting, under Annex A, or restricting under Annex B, the production or use of that substance? [  ] Yes  [  ] No
      If yes, indicate the date of manufacture of article: _______________

(Repeat Part 3 for each substance notified in Part 2 of this form that is listed on Annex A or B of the Stockholm Convention and on Part 2 or Part 3 of the Export Control List)


Attach supplementary sheets as necessary

Send the notice by email, facsimile or by mail to:
Minister of the Environment
c/o Chemical Production Division
Environment Canada
351 St. Joseph Blvd, 11th floor
Gatineau, Quebec
Facsimile: 819-938-4218
SEC-ECS@ec.gc.ca

The Regulations require notification to be provided at least 30 days prior to the first export indicated on the notice. This form may be used to provide more than one notification under these Regulations. Exporters are required to notify the Minister of any corrections to the information provided in the notice within 30 days after learning of them.


Part 4: Declaration

I declare that the information provided in this report is accurate and complete. I understand that the information provided in this notice may be released to the country of destination.

________________________________________________________
Name of exporter or duly authorized representative (please print):

________________________________________________________
Title:

_______________________________________
Signature:

_______________________________________
Date and Place:

Date modified: