APPLICATION FOR REGISTRATION - CONTROLLED GOODS PROGRAM (CGP)

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Internal Use Only

CGP File No.

Any false statement, misrepresentation or concealment of any material fact on this application or any document presented in support of this application may lead to denial, suspension or revocation of registration and be grounds for criminal prosecution.

Read instructions carefully

Incomplete Applications for Registration will not be processed and will be returned to the addressee.

Once fully completed application and supporting documentation have been received, allow 45 calendar days to process.

A. PREFERRED LANGUAGE OF CORRESPONDENCE

English French

B. TYPE OF APPLICATION

New Renewal Amendment

For New and Renewal Applications, complete all sections of the form.

For Amendment Applications, complete Sections A, B, C and H, as well as any other section where there are changes from the original application. If a section does not apply, indicate "N/A" (not applicable).

In any instance where this form does not allow sufficient space for a complete answer, attach a separate page as required.

C. BUSINESS INFORMATION

1. Type of Business (attach evidence of the legal status of the business)

Sole Proprietor
Partnership
Corporation
Other (specify)

2. Legal Name

3. Business Name (if different from legal name)

4. Head Office Civic Address

5. Mailing Address (if different from Head Office)

Telephone Number

Facsimile No.

E-mail

6. Company Website

7. Number of employees in your organization

8. Number of employees in your organization that are or will be in a position to examine, possess or transfer controlled goods

D. REGISTRATION JUSTIFICATION

9. Briefly describe your organization's business activities relating to controlled goods.

Controlled Goods

10. Provide a description of the controlled goods the applicant intends to examine, possess or transfer (Refer to the Export Control List (ECL))

10. a. Description of Controlled Goods

10. a. ECL Group No.

10. a. ECL Item No.

10. b. Description of Controlled Goods

10. b. ECL Group No.

10. b. ECL Item No.

10. c. Description of Controlled Goods

10. c. ECL Group No.

10. c. ECL Item No.

10. d. Description of Controlled Goods

10. d. ECL Group No.

10. d. ECL Item No.

10. e. Description of Controlled Goods

10. e. ECL Group No.

10. e. ECL Item No.

Business Contract/Work Obligations

11. Controlled good(s) contract with the following government dept./organization

12. Length of Contract

Start Date (YYYY-MM-DD)

End Date (YYYY-MM-DD)

13. Contact Person (Reporting Authority)

13. Surname

13. Given Name

13. Business Telephone

13. E-mail

Other Requirements

14. Provide other reasons for registration

E. BUSINESS SITE

Provide any business site address where controlled goods will be kept

Site (1) To Be:

Site (1) To Be:

Added Amended Removed

15. Site (1) Civic Address

16. Site (1) Are controlled goods kept at this location?

16. Are controlled goods kept at this location?

Yes No

17. Site (1) Number of employees accessing controlled goods at this site

17. a. Description of Controlled Goods

17. a. ECL Group No.

17. a. ECL Item No.

17. b. Description of Controlled Goods

17. b. ECL Group No.

17. b. ECL Item No.

17. c. Description of Controlled Goods

17. c. ECL Group No.

17. c. ECL Item No.

17. d. Description of Controlled Goods

17. d. ECL Group No.

17. d. ECL Item No.

17. e. Description of Controlled Goods

17. e. ECL Group No.

17. e. ECL Item No.

18. Has a security plan been implemented for this business site?

Yes No

If you answered No to question 18, be reminded that this is a condition of registration provided under section 10 (e) of the Controlled Goods Regulations that requires a registered person to establish and implement a security plan in respect of each place of business in Canada where controlled goods are kept. Failure to comply with this condition constitutes a serious breach of the regulations for which you could be charged under subsection 45(2) of the Defence Production Act and which may result in the suspension/revocation of your registration.

19. Will records of transfers of controlled goods be kept at this location?

Yes No

20. Will records of employee security assessments be kept at this location?

Yes No

21. If you answered No to question 19 or/and 20, provide the address of the location where the records will be kept

22. Surname, Given name of the Designated Official (D.O.) responsible for this site

23.

DO's Telephone No.

DO's Facsimile No.

DO's Email

To add more business sites go to Schedule 1 attached.

F. OWNERSHIP INFORMATION

Identify individual(s) and/or business(es) that own 20% or more of the voting shares, and indicate percentage of ownership. For business(es) identified, provide ownership information up to and including the ultimate owner in the corporate tree, and whether the organization is publicly traded, following the format below. Examples on how to complete this section are found in Section F of the instructions attached.

Please indicate if your organization is publicly traded.

Please indicate if your organization is publicly traded.

Yes No

1a -

1a - Name

1a - Ownership %

1a - Head Office Mailing Address

1b -

1b - Name

1b - Ownership %

1b - Head Office Mailing Address

1c -

1c - Name

1c - Ownership %

1c - Head Office Mailing Address

2. Please indicate if your organization is publicly traded.

Please indicate if your organization is publicly traded.

Yes No

2a -

2a - Name

2a - Ownership %

2a - Head Office Mailing Address

2b -

2b - Name

2b - Ownership %

2b - Head Office Mailing Address

2c -

2c - Name

2c - Ownership %

2c - Head Office Mailing Address

3. Please indicate if your organization is publicly traded.

Please indicate if your organization is publicly traded.

Please indicate if your organization is publicly traded. Yes Please indicate if your organization is publicly traded. No

3a -

3a - Name

3a - Ownership %

3a - Head Office Mailing Address

3b -

3b - Name

3b - Ownership %

3b - Head Office Mailing Address

3c -

3c - Name

3c - Ownership %

3c - Head Office Mailing Address

G. BUSINESS OFFICIALS

To Be:

To Be:

Added Amended Removed

Identify each Officer(s), Director(s), Partner(s), Proprietor(s).

A. Surname, Given Name

A. Residential Address

A. Position/Title

A. Home Tel. No.

B. Name, Surname

B. Residential Address

B. Position/Title

B. Home Tel. No.

C. Name, Surname

C. Residential Address

C. Position/Title

C. Home Tel. No.

If more space is required go to Schedule 2 attached.

H. CERTIFICATION AND CONSENT

(Only an individual identified in Section G above may complete this section)

I, the undersigned, as the individual authorized by the applicant, do hereby certify that the information contained in this application is true, complete and correct. I ackknowledge and agree to comply with the responsibilities outlined in the Defence Production Act and the Controlled Goods Regulations with respect to the examination, possession or transfer of controlled goods.

Surname, Given Name

Position/Title

Business Mailing Address

Business Tel. No.

Business Facsimile No.

Business Email Address

Consent for Publication

In accordance with s.37 (2) of the Defense Production Act in order to assist all registered persons in exercising due diligence when transferring controlled goods to another person, the Controlled Goods Directorate has an obligation to make available on its Web site a list of all persons registered with the Controlled Goods Program and permitted to possess, examine or transfer controlled goods.

Consent to display information on the Controlled Goods Directorate (CGD) Web site will result in details being available to the public online. Select one of the following options.

Select one of the following options.

I do not consent to have the organization's name, head office civic address and phone number posted on the Controlled Goods Directorate (CGD) Web site.

I consent to have the following information posted on the CGD website. (Select one).

Name of registered person, province and registration expiry date

Name of registered person, full address and registration expiry date

Name of registered person, full address, registration expiry date
and general contact number

Name of registered person, full address, registration expiry date,
name of DO and a contact number

Signature of authorized individual

Date (YYYY-MM-DD)

Print Name

Proctection of information

Personal information provided on this application is protected and used in accordance with the provisions of the Privacy Act (Personal Information Bank Number PWGSC PPU 045). The information is collected under the authority of the Defence Production Act to determine the current and ongoing entitlement of your company to register with the Controlled Goods Program. The information may be verified.

SCHEDULE 1 - ANNEXE 1

E. BUSINESS SITE (Cont'd)

Provide any business site address where controlled goods will be kept

Site (2) To Be:

Site (2) To Be:

Added Amended Removed

Site (2) 1. Civic Address

2. Site (2) Are controlled goods kept at this location?

2. Are controlled goods kept at this location?

Yes No

Site (2) 3. Number of employees accessing controlled goods at this site

Site(2) 3. a. Description of Controlled Goods

Site(2) 3. a. ECL Group No.

Site(2) 3. a. ECL Item No.

Site(2) 3. b. Description of Controlled Goods

Site(2) 3. b. ECL Group No.

Site(2) 3. b. ECL Item No.

Site(2) 3. c. Description of Controlled Goods

Site(2) 3. c. ECL Group No.

Site(2) 3. c. ECL Item No.

Site(2) 3. d. Description of Controlled Goods

Site(2) 3. d. ECL Group No.

Site(2) 3. d. ECL Item No.

Site(2) 3. e. Description of Controlled Goods

Site(2) 3. e. ECL Group No.

Site(2) 3. e. ECL Item No.

Site (2) 4. Has a security plan been implemented for this business site?

4. Has a security plan been implemented for this business site?

Yes No

If you answered No to question 4, be reminded that this is a condition of registration provided under section 10 (e) of the Controlled Goods Regulations that requires a registered person to establish and implement a security plan in respect of each place of business in Canada where controlled goods are kept. Failure to comply with this condition constitutes a serious breach of the regulations for which you could be charged under subsection 45(2) of the Defence Production Act and which may result in the suspension/revocation of your registration.

Site (2) 5. Will records of transfers of controlled goods be kept at this location?

5. Will records of transfers of controlled goods be kept at this location?

Yes No

Site (2) 6. Will records of employee security assessments be kept at this location?

6. Will records of employee security assessments be kept at this location?

Yes No

Site (2) 7. If you answered No to question 5 or/and 6, provide the address of the location where the records will be kept

Site (2) 8. Surname, Given name of the Designated Official (D.O.) responsible for this site

Site (2) 9. DO's Telephone No.

Site (2) 9. DO's Facsimile No.

Site (2) 9. DO's Email

Site (3) To Be:

Site (3) To Be:

Added Amended Removed

Site (3) 1. Civic Address

Site (3) 2. Are controlled goods kept at this location?

2. Are controlled goods kept at this location?

Yes No

Site (3) 3. Number of employees accessing controlled goods at this site

Site (3) 3. a. Description of Controlled Goods

Site (3) 3. a. ECL Group No.

Site (3) 3. a. ECL Item No.

Site (3) 3. b. Description of Controlled Goods

Site (3) 3. b. ECL Group No.

Site (3) 3. b. ECL Item No.

Site (3) 3. c. Description of Controlled Goods

Site (3) 3. c. ECL Group No.

Site (3) 3. c. ECL Item No.

Site (3) 3. d. Description of Controlled Goods

Site (3) 3. d. ECL Group No.

Site (3) 3. d. ECL Item No.

Site (3) 3. e. Description of Controlled Goods

Site (3) 3. e. ECL Group No.

Site (3) 3. e.. ECL Item No.

Site (3) 4. Has a security plan been implemented for this business site?

4. Has a security plan been implemented for this business site?

Yes No

Site (3) 5. Will records of transfers of controlled goods be kept at this location?

5. Will records of transfers of controlled goods be kept at this location?

Will records of transfers of controlled goods be kept at this location? Yes Will records of transfers of controlled goods be kept at this location? No

Site (3) 6. Will records of employee security assessments be kept at this location?

6. Will records of employee security assessments be kept at this location?

Yes No

Site (3) 7. If you answered No to question 5 or/and 6, provide the address of the location where the records will be kept

Site (3) 8. Surname, Given name of the Designated Official (D.O.) responsible for this site

Site (3) DO's Telephone No.

Site (3) DO's Facsimile No.

Site (3) DO's Email

Site (4) To Be:

Site (4) To Be:

Added Amended Removed

Site (4) 1. Civic Address

Site (4) 2. Are controlled goods kept at this location?

2. Are controlled goods kept at this location?

2. I. Are controlled goods kept at this location? Yes 2. I. Are controlled goods kept at this location? No

Site (4) 3. Number of employees accessing controlled goods at this site

Site(4) 3. a. Description of Controlled Goods

Site(4) 3. a. ECL Group No.

Site(4) 3. a. ECL Item No.

Site(4) 3. b. Description of Controlled Goods

Site(4) 3. b. ECL Group No.

Site(4) 3. b. ECL Item No.

Site(4) 3. c. Description of Controlled Goods

Site(4) 3. c. ECL Group No.

Site(4) 3. c. ECL Item No.

Site(4) 3. d. Description of Controlled Goods

Site(4) 3. d. ECL Group No.

Site(4) 3. d. ECL Item No.

Site(4) 3. e. Description of Controlled Goods

Site(4) 3. e. ECL Group No.

Site(4) 3. e. ECL Item No.

Site (4) 4. Has a security plan been implemented for this business site?

4. Has a security plan been implemented for this business site?

Has a security plan been implemented for this business site? Yes Has a security plan been implemented for this business site? No

Site (4) 5. Will records of transfers of controlled goods be kept at this location?

5. Will records of transfers of controlled goods be kept at this location?

5. A. Will records of transfers of controlled goods be kept at this location? Yes 5. A. Will records of transfers of controlled goods be kept at this location? No

Site (4) 6. Will records of employee security assessments be kept at this location?

6. Will records of employee security assessments be kept at this location?

Yes No

Site (4) 7. If you answered No to question 5 or/and 6, provide the address of the location where the records will be kept

Site(4) 8. Surname, Given name of the Designated Official (D.O.) responsible for this site

Site (4) 9. DO's Telephone No.

Site (4) 9. DO's Facsimile No.

Site (4) 9. DO's Email

Site (5) To Be:

Site (5) To Be:

Added Amended Removed

Site (5) 1. Civic Address

Site (5) 2. Are controlled goods kept at this location?

2. Are controlled goods kept at this location?

Yes No

Site (5) 3. Number of employees accessing controlled goods at this site

Site (5) 3. a. Description of Controlled Goods

Site (5) 3. a. ECL Group No.

Site (5) 3. a. ECL Item No.

Site (5) 3. b. Description of Controlled Goods

Site (5) 3. b. ECL Group No.

Site (5) 3. b. ECL Item No.

Site (5) 3. c. Description of Controlled Goods

Site (5) 3. c. ECL Group No.

Site (5) 3. c. ECL Item No.

Site (5) 3. d. Description of Controlled Goods

Site (5) 3. d. ECL Group No.

Site (5) 3. d. ECL Item No.

Site (5) 3. e. Description of Controlled Goods

Site (5) 3. e. ECL Group No.

Site (5) 3. e. ECL Item No.

Site (5) 4. Has a security plan been implemented for this business site?

4. Has a security plan been implemented for this business site?

Yes No

Site (5) 5. Will records of transfers of controlled goods be kept at this location?

5. Will records of transfers of controlled goods be kept at this location?

Yes No

Site (5) 6. Will records of employee security assessments be kept at this location?

6. Will records of employee security assessments be kept at this location?

Yes No

Site (5) 7. If you answered No to question 5 or/and 6, provide the address of the location where the records will be kept

Site (5) 8. Surname, Given name of the Designated Official (D.O.) responsible for this site

Site (5) 9. DO's Telephone No.

Site (5) 9. DO's Facsimile No.

Site (5) 9. DO's Email

SCHEDULE 2 - ANNEXE 2

G. BUSINESS OFFICIALS (Cont'd)

G. To Be:

To Be:

Added Amended Removed

G. a. Name

G. a. Residential Address

G. a. Position/Title

G. a. Home Tel. No.

G. b. Name

G. b. Residential Address

G. b. Position/Title

G. b. Home Tel. No.

G. c. Name

G. c. Residential Address

G. c. Position/Title

G. c. Home Tel. No.

G. d. Name

G. d. Residential Address

G. d. Position/Title

G. d. Home Tel. No.

G. e. Name

G. e. Residential Address

G. e. Position/Title

G. e. Home Tel. No.

G. f. Name

G. f. Residential Address

G. f. Position/Title

G. f. Home Tel. No.

G. g. Name

G. g. Residential Address

G. g. Position/Title

G. g. Home Tel. No.