Application Or Reapplication For A Licence To Grow Industrial Hemp For Research Purposes¹

1. APPLICANT :

• 1.1. Name :
  • Surname
  • Given Names
• 1.2. Address:
• 1.3. Birth date (dd/mm/yy):
• 1.4. Tel:
  • Fax:
• 1.5 Reapplication
  • yes
  • no
  • Previous licence numbers (if applicable):

2. OWNER OF THE FIELD, LOT OR FARM PROPOSED FOR HEMP CULTIVATION

• 2.1. Name
  • - if different from 1.1:
    • Surname
    • Given Names
  • Same as 1.1
• 2.2. Address
  • - if different from 1.2 :
  • Same as 1.2
• 2.3. Birth date (dd/mm/yy):
• 2.4. Tel:
  • Fax:

3. RESEARCHER

• Please check if separate pages are attached
• 3.1. Name
  • - if different from 1.1:
    • Surname
    • Given Names
  • Same as 1.1
• 3.2. Address
  • - if different from 1.2 :
  • Same as 1.2
• 3.3. Birth date (dd/mm/yy):
• 3.4. Tel.:
  • Fax :
• 3.5. Research Institution / Company (including faculty, department etc.)
• 3.6. Academic Qualifications
• 3.7. Speciality :
• 3.8. Researcher's responsibility with respect to this initiative
  • Preparation of research statement
  • Development of research objectives
  • Experimental design
  • Conducting of field research
    
  • Data gathering
    
  • Preparation of plant samples for THC testing
  • Data analysis
  • Report writing

4. LOCATION

• 4.1. Field / Lot Number
• 4.2. Description of the location in relation to surrounding fields, roads, habitation
  • Please check if a map or drawing is attached
• 4.3. Brief description of the physical security measures in place/planned:
  • Please check if separate pages are attached

5. THC (DELTA-9 TETRAHYDROCANNABINOL) TESTING

• 5.1. Laboratory
  • Licence number:
  • Name:
  • Address:
• 5.2. Sampling and testing procedures:

  I have read Health Canada's Guidance on Application for Licence to Grow Hemp for Research Purposes and Guidance on Sampling and Analysis of delta-9 THC in Hemp . I agree to perform the sampling according to these guidelines and to submit the samples to the above-licenced laboratory for THC testing and to assume the cost of the analysis.

  • Signature of Applicant
  • Date

6. RESEARCH PROJECT

• 6.1. Research objectives:
  • Please check if separate pages are attached
• 6.2. Research Methodology:
  • Please check if separate pages are attached
• 6.3. Seeded area (hectares):
  • Please check if separate pages are attached

7. HEMP SEED / HEMP VARIETIES

For each hemp variety to be used, please provide the name of the variety, the expected % of THC, the complete name and address of the supplier, the quantity to be used in kg. If hemp seeds are imported on your behalf, please check the squares in the last column and attach a separate sheet with the name and address of the licenced importers.

• Variety Name
• % THC
• Name and address of supplier
• Qty (kg)
• Imp.

Please check if separate pages are attached

8. RECORD KEEPING

1. The applicant must keep records of all movement and use of plant material , including storage and distribution, in order to demonstrate a chain of custody. An up-to-date inventory of the hemp seeds and hemp plants must be maintained. Please provide a short description of the record keeping.
2. The applicant must keep records of all operations with respect to conducting the project , such as sowing, harvesting, sampling and testing. Please provide a short description of the record keeping.

Please check if separate pages are attached

9. END USE OF HARVESTED MATERIAL

• 9.1. END USER : For each end user of harvested material, please specify the name of the individual or company that will perform additional research or transformation of the product, the part of the plant that will be used, the quantity to be provided and the nature of the research or transformation to be undertaken.
  • Name / Phone # / FAX # / Contact
  • Address
  • Plant part and Qty
  • Research / transformation

Please check if separate pages are attached

10. DESTRUCTION OF PLANTS OR PLANT PARTS

• 10.1. PERSONS RESPONSIBLE FOR DESTRUCTION : Please specify the name of the individual or company that will perform destruction of the plant or part of the plant.
  • Name / Phone # / FAX # / Contact
  • Address
  • Plant part
  • Quantity

  Please check if separate pages are attached

• 10.2. DESTRUCTION : Provide a short description of the method to be used to destroy the surplus plant and plant parts that will not be used in the project:

  Please check if separate pages are attached

11. POLICE SERVICES:

• 11.1. Local Police Service:
  • Name:
  • Address:
  • Tel:
• 11.2. Closest Provincial Police Detachment - if different from 11.1 :
  • Name:
  • Address:
  • Tel:
• 11.3. Closest RCMP Detachment - if different from 11.1 :
  • Name:
  • Address:
  • Tel:
• In the event of a security breach, the police service in 11.1 and the Office of Controlled Substances will be notified immediately by the licencee, the landowner or the local operator.
  • Signature of Applicant
  • Date
• 11.4. Letters from the police services in 11.1 and 11.2 indicating that they are aware of your project:
  • Local Police Service
    • Attached
    • Submitted directly by Police Service
  • Provincial Police
    • Attached
    • Submitted directly by Police Service
  • RCMP Detachment
    • Attached
    • Submitted directly by Police Service

12. REPORT PREPARATION

• Projected completion date of project:
• Projected date of report:
• Name of person(s) who will prepare report:

13. OTHER INFORMATION:

Please provide any additional information which you feel may facilitate the (re)issuance of this licence (e.g. grants applied for or received, publications by the applicant regarding this or similar projects).

• Please check if separate pages are attached

I wish to apply for a licence, in accordance with the provisions of the Controlled Drugs and Substances Act , its Narcotic Control Regulations and any relevant aspects of the Industrial Hemp Regulations , in order to cultivate hemp for research purposes as outlined in Section 6 above.

• Signature of Applicant
• Place
• Date