FORM 4 [Paragraph 10(1)] |
APPEAL BOARD
Hazardous Materials Information Review Act
IN THE MATTER OF: |
APPEARANCE
[Hazardous Materials Information Review Act Appeal Board Procedures Regulations,
Form 4, Subsection 10(1)]
TAKE NOTICE that the undersigned intends to participate in these proceedings as | ||
THE CLAIMANT: | ||
AN AFFECTED PARTY AS: | ||
Supplier of the controlled product | ||
Employee at the work place | ||
Employer at the work place | ||
Safety and health professional for the work place | ||
Safety and health representative for the work place | ||
Member of a safety and health committee for the work place | ||
A person who is authorized in writing to represent | ||
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LANGUAGE OF PREFERENCE: | |
ENGLISH | |
FRENCH |
The undersigned will not be represented by counsel. | |
OR | |
The undersigned will be represented by counsel. |
NAME OF COUNSEL: |
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ADDRESS FOR SERVICE: |
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TELEPHONE: |
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OTHER MEANS OF TELECOMMUNICATIONS AND THEIR NUMBERS: |
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SIGNATURE: |
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NAME: |
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FIRM: |
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ADDRESS: |
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TELEPHONE: |
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OTHER MEANS OF TELECOMMUNICATIONS AND THEIR NUMBERS: |