Declaration by Importer of Control Products

Privacy Notice Statement

Health Canada
Collection and use of personal information in this application is in accordance with the federal Privacy Act.

The personal information you provide is collected under the authority of section 36(a) of the Pest Control Product Regulations for the purpose of contacting the applicant in regards to the application and to communicate any decisions and outcomes of the application.

The Privacy Act gives you the rights of access to, correction of and protection of your personal information. For further information about this Privacy statement please contact Health Canada’s Access to Information and Privacy Coordinator by email at atip-aiprp@hc-sc.gc.ca.

Instructions

  • Type or print clearly.
  • Complete and retain last copy.
  • Two copies are to be attached to the customs entry.
  • The Collector of National Revenue will forward the original to the nearest regional office of the Pest Management Regulatory Agency (See below).

All control products imported into Canada for sale or manufacture must be registered under the Pest Control Products Act (PCPA). Those control products imported for research purposes should be so marked on the signed statement, as these are not subject to registration under the Act.

Description of Control Products

  1. Registration Number - If the product has an assigned registration number under the Pest Control Products Act, show the number. For those products regulated under Schedule II of the Pest Control Products Act, state “Scheduled under the Pest Control Products Act”.
  2. Product Name and Active Ingredients - The brand and name of the product should be given in full. For each product, show the active ingredient(s) by common or chemical name and the amount of each active ingredient.
  3. Quantity of Product - Express the amount of product by mass in kilograms or volume in litres.
  4. Purpose for Importation - State the purpose for importation for each product as one of the following: FOR RESALE, FOR MANUFACTURING PURPOSES OR FOR RESEARCH PURPOSES.

Requirements Under the Pest Control Products Act

Collectors of National Revenue may hold any control product until the provisions of the Act and Regulations made thereunder are properly conformed with and may refuse entry and may cause the deportation of any control product when advised by an inspector that it has not been registered by the Act or that its sale in Canada would be contrary to any of the provisions of the Act and Regulations thereunder.

Form

Shipper
Consignee
Importer   
Registration Number PCPA Product name, active ingredients and amounts Quantity (Kg, L) Purpose for Importation (RESALE,
MANUFACTURING, RESEARCH)

Health Canada Regional Offices

Suite 340, 33 Weldon St., Moncton, NB E1C 0N5
FAX: (506) 851-7369

Guy-Favreau Complex, 200 René-Lévesque Blvd West,
Tour Est, 6e étage
Montréal
, QC H2Z 1X4
FAX: (514 ) 283-1844

255 Woodlawn Road, West, Unit 109, Guelph, ON N1H 8J1
FAX: (519) 826-2129

510 Lagimodiere Blvd. Room 136, Winnipeg, MB R2J 3Y1
FAX: (204) 983-5547

2045 Broad St., 5th Floor, Regina, SK S4P 3T7
FAX: (306) 780-3856

9700 Jasper Ave., Room 730, Edmonton, AB T5J 4C3
FAX: (780) 495-2624

4595 Canada Way, Room 400, Burnaby, BC V5G 1J9
FAX: (604) 658-8391

Dating stamp of point at which shipment cleared at customs
I hereby certify that the information provided is complete and correct in respect of this shipment of control product(s) for entry into Canada.     
Privacy Notice Statement