CONTROLLED GOODS PROGRAM (CGP)
CONSENT TO USE A GOVERNMENT OF CANADA SECURITY CLEARANCE

Protected B when completed
Personal Information Bank PWGSC PPU 045

Information provided on this form can only be used for the purpose of a Security Assessment under Section 15 of the Controlled Goods Regulations

A – Administrative Information

B – Security Clearance Information

3 - Period of validity

C – Certification and Consent

I, the undersigned, do hereby certify that the information contained in this consent form is true, complete and correct. I understand the need for a security assessment, since in the course of my duties I will examine, possess or transfer controlled goods. I give my consent to the Controlled Goods Directorate/Designated Official of the above-mentioned registered business to use the security clearance that I obtained from the Government of Canada and any information relative to such clearance. I acknowledge and agree to comply with the responsibilities outlined in the Defence Production Act and the Controlled Goods Regulations with respect to examining, possessing and transferring controlled goods in Canada.

Protection of Information

Personal information provided on this consent form is protected and used in accordance with the provisions of the Privacy Act (Personal Information Bank Number PWGSC PPU 045) and the Personal Information Protection and Electronic Documents Act. The information is collected under the authority of the Defence Production Act. The information may be verified.