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Application Form for International Trade Certificate
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(DOC Version - 203 K)International Trade Certificate
Certificate No.:
Exporter Information
Exporting (certifying) country:
- Canada
- Importing (requesting) country:
Name of applicant/Exporter:
Street address:
City:
- Province:
Country:
- Postal code:
Product Information
Product licence number
Recommended use or purpose
Product brand name
Dosage form
Route of administration:
Sterile dosage:
- Yes
- No
Medicinal ingredient(s) (common name):
Quantity/Dosage Unit:
Potency (If Any):The Above Named Product Has Been Evaluated By Health Canada And Is Authorized For Sale In Canada
Site Information
Authorized activities
- Manufacturing
- Packaging
- Labelling
Building address
Site Licence No
Date of expiry
The above site(s) have been assessed for compliance with the Good Manufacturing Practice requirements of the Natural Health Products Regulations.
Certifying Authority Information
Address of certifying authority:
Natural Health Products Directorate
2936 Baseline Road, AL 3300B
Ottawa, Ontario K1A 0K9
Name of NHPD authorized official
Manager, Site Licence Assessment and Coordination Division
Date of issuance:
