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

Forms for exporters - Export permit application

Part 1: General information

Exporter
Name of exporter:
Name of duly authorized representative:
Address:

Telephone number:
Fax number:
Email address:

For Environment Canada use







Importer
Name:
Address:

Telephone number:
Fax number:
Email address:






Part 2: Identification of the substance or the product that contains the substance:

1. Name of substance as it appears on the Export Control List (Schedule 3 of the Canadian Environmental Protection Act, 1999): _______
2. Common name, if known: _______
3. Trade name, if known: _______
4. CAS registry number: _______
5. Commodity Code of the substance that is obtained from the Harmonized Commodity Description and Coding System: _______


Part 3: Export information

6. Country of Destination: _______
7. Expected date of export: _______
8. Estimated quantity of the substance to be exported: ___ kg
9. Purpose of Export:
    [  ] Destruction
    [  ] Industrial Chemical use
    [  ] Pesticidal use
    [  ] Other use

10. If the substance is contained in a manufactured product indicate:

  1. The name of the product:
  2. Concentration of substance in the product:

11. List the customs office through which the export is expected to exit Canada, if known: _______
12. List any countries through which the substance will transit, if known: _______
13. Proposed number of exports for the calendar year, if known: _______

You must attach the Safety Data Sheet for the substance being exported, or if applicable, for the product that contains the substance.


Attach supplementary sheets as necessary

Send the application 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
ec.substancedexportationcontrolee-exportcontrolledsubstance.ec@canada.ca

Section 10 of the Regulations describes exports that require the exporter to hold a valid export permit issued under the Regulations. A copy of the permit must be included with these exports in addition to the labelling prescribed by section 21.

A minimum of 15 days (7 days (if the person holds a permit to export the substance issued under paragraph 185(1)(b) of the Act or under the Ozone-depleting Substances and Halocarbon Alternatives Regulations) prior notice of export is mandatory under section 5 of the regulations for all exports, including those requiring an export permit.


Part 4: Declaration

I understand that I, as the exporter, assume full responsibility for the removal of the substance from the country of destination and any related costs, including the transportation, care, control and storage of the substance, in the event that the exported substance is in contravention of any conditions set out in the export permit or if the export takes place after the export permit has expired or has been cancelled.

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

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

________________________________________________________
Title
_____________________________
Signature

_____________________________
Date and place

 

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