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Form 6012 - Application for registration of private label product based on registered initial product

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 6(1)(a) of the Pest Control Product Regulations for the purpose of contacting the applicant in regard to the application and to communicate any decisions and outcomes of the application.

Why are we collecting your personal information?

We require your personal information for the purpose of contacting the applicant in regards to the application and to communicate any decisions or outcomes of the application.

Will we use or share your personal information for any other reason?

Company names are disclosed after the Pest Management Regulatory Agency (PMRA) makes a decision or outcome on an application.

What are your rights?

The Privacy Act gives you the rights of access to, correction of and protection of your personal information. You have a right complain to the Privacy Commissioner of Canada if you feel your personal information has been handled improperly. For more information about these rights, or about how we handle your personal information, please contact the PMRA Information Service.

Security notice: up to Protected B only

This site is not approved by Health Canada/Public Health Agency of Canada for storage above Protected B information. Only up to Protected B information may be stored on this site.

Instructions

About this online form

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How to work with this online form

When working with this online form, you can save it to your computer at any time by clicking the 'Save Draft' button at the bottom of the form. This will generate a draft XML file.

You can continue to work on the form in subsequent sessions by loading a draft XML file in the "Load a draft XML file" section, at the top of the form.

Once you have completed the form, click the 'Save Final' button at the bottom of the form to generate a Microsoft Word file.

Instructions for completing sections of this online form

To continue to work off an existing form, browse for the draft file (in XML format) here:

Initial Product Instruction1
Initial Product Registrant Name and Address Instruction2
Private Label Applicant Name and Mailing Address Instruction3
Submission Contact Instruction4
Communication Instruction5

Formal correspondence, including the Registration Letter, Certificate of Registration, and Approved Label text will be sent to the Regulatory Mailing Address.

Private Label Instruction6
Container Material (required)
Size of container
or Size(s) / units
Declaration Instruction7

Specifications, including sources of all ingredients, will be the same for the Private Label product as for the Initial Product. The Private Label product will be made on the same production line as the Initial Product. The Private Label will differ only in product name, company address, registration number and trade dress.

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