Form 6200 - Import certificate for the Grower Requested Own Use (GROU) program

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 42(2)(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

This form is to initiate an application for a certificate to import and use a foreign-registered pest control product that has been approved through the Grower Requested Own Use (GROU) program. See the Pest Management Regulatory Agency (PMRA) website or call 1-800-267-6315 for details on the GROU Program.

When authorized by a Pest Management Regulatory Agency official, the application becomes the Import Certificate, and is not transferable. The Certificate is valid for one importation prior to the Certificate expiry date. Additional importations will require a new Certificate.

How to work with this online form

When working with this online form, you can save it to your computer at any time by pressing 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, press the 'Save Final' button at the bottom of the form to generate a Microsoft Word file.

Instructions for completing sections of this online form

Instruction 1

Name: State name of importer.

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Instruction 2

Location / Address of farm: Indicate the address of the farm where the treatment will occur, consistent with section «Pesticide Product to be applied at».

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Instruction 3

Telephone Number: Include area code.

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Instruction 4

Email address: indicate the email address where the decision documents, including approved import certificate will be directed.

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Instruction 5

Mailing Address: Indicate mailing address and postal code for importer.

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Instruction 6

Foreign Product Name: State name of foreign pest control product.

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Instruction 7

Foreign Registration Number: Indicate pest control product registration number, e.g., for United States product, state the United States EPA registration number.

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Instruction 8

GROU Equivalency Certificate Number: Indicate the Equivalency Certificate number appearing on the GROU Approved Labels (Container Label and Direction for Use Booklet) that are available on the PMRA website. The Container Label must be sent with this application.

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Instruction 9

Active Ingredient: Indicate common or chemical name of the active ingredient as identified in the "GUARANTEE" on the GROU Approved Labels or Directions for Use Booklet.

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Instruction 10

Total Area of Land to be Treated (metric or imperial units): metric or imperial units.

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Instruction 11

Crop or Use: Identify use or crop to be treated.

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Instruction 12

Timing of Application: Indicate timing of application (see examples below)

Post-harvest
Preplant
Pre-emergent
Early postemergent
Spot treatment - pre-harvest, fall stubble

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Instruction 13

Quantity of Product for One Use Season: State the total amount of product (not to exceed the amount required for one calendar year) in metric, imperial or United States units you are importing.

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Instruction 14

Province(s) Where Product is to Be Applied: List the province(s) where treatment will occur.

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Instruction 15

Date of Import: Indicate the date the product is expected to enter Canada.

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Instruction 16

Point of Entry: Indicate the expected Canadian point of entry (border crossing).

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Instruction 17

Name of Transporter (if applicable): If applicable, indicate the name of the transportation company or individual bringing the shipment into Canada. Only required if individual or company transporting the shipment does not match the name in Box 1. See PMRA website for restrictions and further details.

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Instruction 18

Pest control product to be applied at (if applicable): List the field locations to be treated. Not required for all products. See PMRA website for restrictions and further details.

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Instruction 19a

Fax or mail a copy of the container label with this application. The GROU Approved Labels (the Container Label and the Directions for Use Booklet) are available on the PMRA website.

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Instruction 19b

For GROU, it is a requirement to send with this form proof of participation in an acceptable container disposal program consistent with registered pest control products. See the PMRA website for details.

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Instruction 20

Liability Statement: Date and signature required. The completed and signed GROU import certificate application must be submitted by email to the Pest Management Regulatory Agency: pmragrou.piapdaarla@hc-sc.gc.ca

For any questions, contact the Pest Management Information Service at 1-800-267-6315 or 613-736-3799 or by e-mail at pmra.infoserv@hc-sc.gc.ca, or pmragrou.piapdaarla@hc-sc.gc.ca

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Load a draft XML file

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

Importer Information

Name^Instruction1

Location / Address of Farm^Instruction2

Telephone Number^Instruction3

Email address^Instruction4

Mailing Address^Instruction5

Foreign Product Information

Foreign Product Name^Instruction6

Foreign Registration Number^Instruction7

GROU Equivalency Certificate Number^Instruction8

Active Ingredient^Instruction9

Proposed Use

Total Area of Land to be Treated (metric or imperial units)^{Instruction10}

Crop or use^{Instruction11}

Timing of Application^{Instruction12}

Quantity of Product for one use season with units^{Instruction13}

Province(s) where product is to be applied^{Instruction14}

Importation Details

Date of Import ^{Instruction15}

Point of Entry^{Instruction16}

Name of Transporter (if applicable)^{Instruction17}

Pest control product to be applied at (if applicable) ^{Instruction18}

Field, Lot or Quarter

Concession or Section

Township

County or Range

Municipality

I have enclosed a copy of the GROU approved container label with this application and I am in possession of the GROU approved Directions for Use Booklet. ^{Instruction19a}

I have provided proof of participation in an acceptable container disposal program with this application. ^{Instruction19b}

Liability Statement ^{Instruction20}

I, the importer and user, accept responsibility for compliance with the terms and conditions of the authorization of this certificate and assume all risks and responsibility for and in connection with the import, handling and use of this product and I shall be liable for all loss or damage resulting from the import, handling and use of the product including damage to treated crops and properties or properties of others, injury to persons and occupational health and safety, etc. and shall indemnify and save harmless the Crown from all such loss or damage. I am aware that as an importer I am responsible for the disposal of pesticide containers covered by this Certificate as indicated on the GROU Approved Labels.

I the importer and user do hereby certify that this information is complete and correct in respect of this shipment of pest control product for importation into Canada.

Signature of importer

Date

By submitting your personal information, you are consenting to its collection, use and disclosure in accordance with the privacy notice statement.

Please ensure that you complete the 'Signature' field either on the downloaded DOC version of the form, or on the paper version, as applicable.

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