Sales Information Reporting Form

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Registrants are required to submit annual sales data using the following electronic PDF form:

Sales Information Report

Please refer to the Guidance Document for detailed information on filling out this form. Save the file before attempting to fill in the report. Save often to ensure data is not lost.

General Information

1. Type of Report - Annual Report / Amendment / Interim Report

Amendment Description

Time period of interim report - Start / End

Registrant Information

2. Full Legal Name of Registrant (no abbreviations)

3. Postal Address of the Registrant Postal Delivery Address line 1; Postal Delivery Address line 2; Postal Delivery Address line 3; City / Town; Province / State; Country; Postal Code / Zip

Reporter's Information

4. Person Completing the Report - Name; Job Title

5. Business Telephone; Business Fax; Business Email

6. Is the reporter's business address the same as above? Yes / No

7. Address of Person/Registrant Completing the Report - Postal Delivery Address line 1; Postal Delivery Address line 2; Postal Delivery Address line 3; City / Town; Province / State; Country; Postal Code / Zip

8. Calendar Year of the Report

9. Date Report was Completed

10. Please list the registration numbers of products with no sales. This includes technical and manufacturing concentrates that are only used in-house - Add; Entries; Add / Delete Blanks

To report sales, proceed to the next sub-form by clicking the Forward "" button at the top or bottom of the page. If reporting only products with no sales, click "Here" to proceed to the Report Completed sub-form.

Additional Information

Add a Sales Information Sub-form - Add

Sales Information: One Sub-form per Registration Number

11. Registration No.; Company

12. Product Name

13. Product Classification - Technical / Manufacturing Concentrate / Commercial / Domestic / Restricted / Commercial and Manufacturing Concentrate / Commercial and Restricted

14. Unit of measure used to report this product. Only metric units are acceptable. Provide only one unit - Unit / Other unit

15. Did this product change ownership during the calendar year of this report? Yes / No

15. a) Time period of report - Start / End

17. Quantity of pesticide sold in Canada (total quantity)

18. Is this pesticide registered only for the manufacture of pest control products? Yes / No

18. a) Quantity of pesticide sold to manufacturers of products regulated under the Feeds Act or Fertilizers Act (total quantity)

18. b) If the manufacturers in Question 18. a) also make products for non-Canadian markets, explain how the quantity declared in Question 18. a) represents only what is sold into Canada.

19. Can the quantity of pesticide contained in the products made by the manufacturer in Question 18. a), and made available for sale by vendors to users, be reported or estimated by the registrant (province and territory totals)? Yes / No

19. a) Quantity of pesticide contained in products regulated under the Feeds Act or Fertilizer Act made by the manufacturers in Question 18. a) and made available for sale by vendors to users (province and territory totals) - Province / Territory; Quantity

19. b) Was this number estimated? Newfoundland and Labrador Yes / No Prince Edward Island Yes / No Nova Scotia Yes / No New Brunswick Yes / No Quebec Yes / No Ontario Yes / No Manitoba Yes / No Saskatchewan Yes / No Alberta Yes / No British Columbia Yes / No Yukon Territory Yes / No Northwest Territories Yes / No Nunavut Yes / No

19. c) Estimation Method

20. a) Quantity of pesticide sold for the manufacture of products without a Pest Control Products Act Registration Number such as paints and plastics (net total quantity, province and territory totals). Do not report treated seed, fertilizer-pesticide or feed-pesticide combination products here. Province / Territory; Quantity; Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon Territory, Northwest Territories, Nunavut.

20. b) If the manufacturers in Question 20. a) also make products for non-Canadian markets, explain how the quantity declared in Question 20. a) represents only the quantity sold into Canada.

21. Quantity of pest control product sold in Canada (total quantity).

22. Is this product sold to treat seed or manufacture products regulated under the Feeds Act or Fertilizers Act? Yes / No

22. a) Quantity of pesticide sold to treat seed or manufacture products regulated under the Feeds Act or Fertilizers Act (total quantity).

22. b) If the manufacturers in Question 22. a) also make products for non-Canadian markets, please explain how the quantity declared in Question 22. a) represents only what is sold into Canada

23. Can the quantity of pesticide contained in the products made by the manufacturers in Question 22. a), and made available for sale by vendors to users, be reported or estimated by the registrant? Yes / No

23. a) Quantity of pesticide contained in products regulated under the Feeds Act or the Fertilizers Act, or used to treat seeds, that was made available for sale by vendors to users (provincial and territorial totals) - Province / Territory Quantity

23. b) Was this number estimated? Newfoundland and Labrador Yes / No Prince Edward Island Yes / No Nova Scotia Yes / No New Brunswick Yes / No Quebec Yes / No Ontario Yes / No Manitoba Yes / No Saskatchewan Yes / No Alberta Yes / No British Columbia Yes / No Yukon Territory Yes / No Northwest Territories Yes / No Nunavut Yes / No

23. c) Estimation Method

24. Quantity of pest control product sold directly to regional and national distributors (net quantity, provinces and territory totals). Province / Territory; Quantity; Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon Territory, Northwest Territories, Nunavut

25. Can the quantity of pest control product made available for sale by regional and national distributors be reported or estimated by the registrant? Yes / No

25. a) Quantity of pest control product made available for sale to users by regional and national distributors (province and territory totals). If the quantities to be reported in this Question are the same as those reported in Question 24, click the "Copy" button Copy / Reset - Copy / Reset

25. b) Quantity

25. c) Was this number estimated? Newfoundland and Labrador Yes / No Prince Edward Island Yes / No Nova Scotia Yes / No New Brunswick Yes / No Quebec Yes / No Ontario Yes / No Manitoba Yes / No Saskatchewan Yes / No Alberta Yes / No British Columbia Yes / No Yukon Territory Yes / No Northwest Territories Yes / No Nunavut Yes / No

25. d) Estimation Method

26. Quantity of pest control product sold directly to users, vendors and provincial distributors (net quantity, province and territory totals)  Province / Territory; Quantity; Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon Territory, Northwest Territories, Nunavut

27. Additional Information

To add another product, click the Add "+" button at the top or bottom of the page. If finished reporting products, click the Forward "" button at the top or bottom of the page to proceed to the "Report Completed" sub-form.

Report Completed

The form has been successfully completed. Save your work and submit this document to the PMRA. Do not print or scan this form for signing. Sign by typing a text signature. Please use the e-Index Builder to compile this Sales Information Report into PRZ format. Submit the PRZ file through the Electronic Pesticide Regulatory System (e-PRS) Secure Web Portal, or by e-mail to PMRA-ARLA.Docs@hc-sc.gc.ca with "Sales Report PRZ" in the subject line. Please note that submitting this report by email to PMRA-ARLA.Docs@hc-sc.gc.ca is not considered a secure means of transmitting confidential business information. Reports can also be burned onto a CD or DVD and sent by courier or regular mail to the PMRA.

Certification: I certify that the information in this report is true and complete to the best of my knowledge and belief and is provided in good faith.

Date

Text Signature

Electronic Signature (optional)