Drug Establishment Licence Fee Form

Contact Information

Our Mandate:

To promote good nutrition and informed use of drugs, food, medical devices and natural health products, and to maximize the safety and efficacy of drugs, food, natural health products, medical devices, biologics and related biotechnology products in the Canadian marketplace and health system.

Disclaimer

This document does not constitute part of the Food and Drugs Act (Act) or its associated Regulations and in the event of any inconsistency or conflict between that Act or Regulations and this document, the Act or the Regulations take precedence. This document is an administrative document that is intended to facilitate compliance by the regulated party with the Act, the Regulations and the applicable administrative policies. This document is not intended to provide legal advice regarding the interpretation of the Act or Regulations. If a regulated party has questions about their legal obligations or responsibilities under the Act or Regulations, they should seek the advice of legal counsel.

Drug Establishment Licence Fee Form

Company Name:

DEL #:

Mailing Address

Street:

Suite:

Post Office Box:

City:

Province:

Postal Code:

Contact Person:

Language: English French

Telephone:

Fax:

Email:

Billing Address

Street:

Suite:

Post Office Box:

City:

Province:

Postal Code:

Contact Person:

Language: English French

Telephone:

Fax:

Email:

Only for applicants who have not completed their first calendar year:

"I certify that I have not completed my first calendar year of conducting activities under an establishment licence".

Name of Authorized Signing Official
Title
Signature
Date (yy-mm-dd)

For all applicants:

"I certify that the information given on this form and in any documents attached is correct, complete, and fully discloses the total Canadian revenue from the sales of products covered by the establishment licence".

Name of Authorized Signing Official
Title
Signature
Date (yy-mm-dd)