APPLICATION FOR A
CLAIM FOR EXEMPTION
(Confidential when completed)
Note: In this application, "HMIRR" means the Hazardous Materials Information Review Regulations.
MAILING ADDRESS OF CONTACT PERSON (IF DIFFERENT FROM ABOVE)
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Note: This application has been designed to accommodate one or more than one claim for exemption in accordance with section 4 or 5 of the HMIRR.
For each controlled product included in the claim or claims for exemption, give the product identifier |
Indicate Registry Number previously assigned (if applicable) |
Indicate the subject of the claim for exemption by using the appropriate reference (i.e. A, B, etc.) listed in Part III of this application |
Registry Number (for Commission use only) |
SUPPLIER
EMPLOYER
Note: This Part seeks the basic information necessary for the Commission to review a claim for exemption. Under subsection 14(1) of the Act a screening officer may request a claimant to submit such additional information as the screening officer may require. If this application is filed in respect of more than one claim for exemption (section 4 or 5 of the HMIRR) and the information that supports the claims differs, a separate copy of this Part shall be completed in respect of each controlled product for which the information differs. |
Do not disclose in this Part information considered to be confidential business information. If it is necessary to disclose such information in order to meet the requirements of this Part, do so on a separate sheet and enclose it together with a completed Part VII of this application in a separate sealed envelope. |
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1. Basic Fee calculations |
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CLAIMANT IS TO SUBMIT TOTAL FEE UNLESS QUALIFYING CRITERIA FOR "SMALL BUSINESS" ARE MET (SEE FOLLOWING)
2. Fees for small businesses (section 7 of the HMIRR)
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(1) Eligibility as a small business |
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YES _______ NO _______ |
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YES _______ NO _______ |
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(2) Fee for a small business claimant 1/2 x (amount of Total Fee, above) |
Note: Complete this Part, place it in a sepearte sealed envelope and submit it together with Parts I to VI of this
application.
Use more than one page if required.
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ADDRESS CORRECTION
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CONTACT PERSON: | TELEPHONE: | |||
TITLE: | FAX: | |||
E-MAIL ADDRESS: |
PART A [for claims where subject matter pertains to the chemical identity or concentration of one or more ingredients in a controlled product under HMIRR subparagraph 8(1)(e)(i) and/or (ii) or 8(1)(f)(i) and/or (ii)]
Code name, code number or product identifier for each controlled product included in Part II | Generic chemical identity of the ingredient(s) for which exemption is claimed | CAS registry number of the ingredient(s) for which exemption is claimed (if available) | Confidential business information for which exemption is claimed (e.g., the specific chemical identity that is the subject of the claim for exemption) | Registry Number (for Commission use only) |
PART B [for claims where subject matter is also or exclusively set forth under
HMIRR subparagraph 8(1)(f)(iii) and/or (iv)]
NOTE: THIS PART IS NOT REQUIRED TO BE SUBMITTED IF NOT APPLICABLE TO THE CLAIM
Code name or code number of controlled product | Chemical name, common name, trade name or brand name which is part of the subject matter of the claim | Information that would be used to identify the supplier of the controlled product | Registry Number (for Commission use only) |