Export of Substances on the Export Control List Regulations guidance document: notice of export form

Please download, fill, print and send back the PDF version of the above form. This HTML version is provided for on-line reading.

Part 1: general information

Exporter

Name of exporter:
Name of duly authorized representative:
Address:
Telephone number:
Fax number:

Email address:  

For Environment Canada use

Part 2: export notification

Cells have been left purposely empty to demonstrate which areas of the form need to be filled in.

Are any of the above substances classified as “hazardous waste” or “hazardous recyclable material” under the Export and Import of Hazardous Waste and Hazardous Recyclable Material Regulations?

[  ] Yes  [  ] No

If yes, please indicate which substance(s): __________

Part 3: exports subject to the Stockholm Convention for substances listed on part 2 or part 3 of the Export Control List

For all substances notified in part 2 of this form which are found on part 2 or part 3 of the Export Control List and listed in annex a or b of the Stockholm Convention and in force for Canada, please complete the following:

Name of substance: ____________________

1. Specific exemption or acceptable purpose applicable to the substance being exported (if applicable): _______
   
2. Is the substance being exported for environmentally sound disposal in accordance with paragraph 1(d) of article 6 of the Stockholm Convention?
     [  ] Yes  [  ] No  If yes, please indicate:
       Facility name and civic address: _______________
       Method of disposal: _______________
   
3. Is the substance being exported for use:
   1. in a laboratory for analysis [  ] Yes  [  ] No
   2. in scientific research [  ] Yes  [  ] No; or
   3. as a laboratory analytical standard? [  ] Yes  [  ] No
4. Is the substance being exported contained in a manufactured article? [  ] Yes  [  ] No
   If yes,
   1. Is the substance incidentally present in trace amounts? [  ] Yes  [  ] No
   2. Was the article containing the substance manufactured on or before the coming into force for Canada of a provision of the Stockholm Convention prohibiting, under annex a, or restricting under annex b, the production or use of that substance? [  ] Yes  [  ] No
      If yes, indicate the date of manufacture of article: _______________

(Repeat part 3 for each substance notified in part 2 of this form that is listed on annex a or b of the Stockholm Convention and on part 2 or part 3 of the Export Control List)

Attach supplementary sheets as necessary

The regulations require notification to be provided at least 15 days (at least 7 days if the person holds a permit to export the substance issued under paragraph 185(1)(b) of the act or under the Ozone-depleting Substances and Halocarbon Alternatives Regulations) prior to the first export indicated on the notice. This form may be used to provide more than one notification under these regulations. Exporters are required to notify the Minister of any corrections to the information provided in the notice within 30 days after learning of them.

Send the notice by email, facsimile or by mail to:
Minister of the Environment
c/o Chemical Production Division
Environment and Climate Change Canada
351 Saint-Joseph Blvd 11th floor
Gatineau QC
Facsimile: 819-938-4218
ec.substancedexportationcontrolee-exportcontrolledsubstance.ec@canada.ca

Part 4: declaration

I declare that the information provided in this report is accurate and complete. I understand that the information provided in this notice may be released to the country of destination.