Application for Permit to Import Class A Precursors

Under the provisions of the Controlled Drugs and Substances Act and the Precursor Control Regulations

APPLICANT (IMPORTER)

• Name
• Licence Number
• Address
• Business number

SUPPLIER (EXPORTER)

• Name
• Address

PROPOSED CUSTOMS BROKER (IF ANY)

• Name
• Address

SHIPMENT

• Proposed port of entry
• Proposed means of transport
  • Air
  • Land
  • Sea
• Proposed date of entry into Canada
• Name of the proposed carrier
• Name of any proposed country of transit or transhipment

PRECURSOR(S)

*as stated on the licence

• PRECURSOR(S)
  • Name*
  • Harmonized System Code*
  • Quantity
  • Purity, if raw material
• PREPARATION OR MIXTURE
  • Name
  • Quantity of preparation or mixture
  • Quantity of precursor

CERTIFICATION

I hereby certify that I wish to apply for an import permit for Class A precursor(s) and that the information provided in this application is correct and complete, to the best of my knowledge, and in accordance with the relevant sections of the Controlled Drugs and Substances Act and the Precursor Control Regulations.

I hereby consent to the disclosure of information contained in the application to the International Narcotics Control Board and the competent authority in the country of export for the purpose of verifying this information.

FOR OFFICIAL USE ONLY

• Export Permit No. PI -
• Expiry date
• Effective date
• Processed
• Finalized
• Verified