"Application for a Pesticide Vendor Licence" - Newfoundland and Labrador, Canada

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Government of Newfoundland and Labrador
Department of Municipal Affairs and Environment
Privacy Notice
Under the authority of the Environmental Protection Act SNL 2002 cE-14.2, personal information will be
collected for the purpose of enforcing the Pesticides Control Regulations 2012. This allows the
Department of Municipal Affairs and Environment to disclose personal information to other Federal
and Provincial Departments and Agencies.
Notice: Please be advised that, in accordance with Government's Proactive Disclosure Initiative, your
licence will be posted online subject to any exceptions to disclosure provided under the Access to
Information and Protection of Privacy Act, 2015.
APPLICATION FOR A PESTICIDE VENDOR LICENCE
UNDER THE ENVIRONMENTAL PROTECTION ACT SNL 2002 cE-14.2
1. Name of Applicant: ____________________________________________________
2. Address: _____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. Contact Info: _________________
__________________
_________________
Email Address:_______________________________________________________
4. Has a Vendor Licence been held previously in this province? YES NO 
*If YES, Vendors Licence Number held previously was: ______________________
Both: 
6. Nature of business:
Retail:
Wholesale:
7. Name, address, and telephone number of person(s) who holds a Certified Pesticide
Vendor Licence with your company:
Certified Pesticide Vendor Licence Number: ___________________________
Name: __________________________________________________________
Address (If different than Question 2):
_______________________________________________________________________________________________
____________________________________________________________________________
Government of Newfoundland and Labrador
Department of Municipal Affairs and Environment
Privacy Notice
Under the authority of the Environmental Protection Act SNL 2002 cE-14.2, personal information will be
collected for the purpose of enforcing the Pesticides Control Regulations 2012. This allows the
Department of Municipal Affairs and Environment to disclose personal information to other Federal
and Provincial Departments and Agencies.
Notice: Please be advised that, in accordance with Government's Proactive Disclosure Initiative, your
licence will be posted online subject to any exceptions to disclosure provided under the Access to
Information and Protection of Privacy Act, 2015.
APPLICATION FOR A PESTICIDE VENDOR LICENCE
UNDER THE ENVIRONMENTAL PROTECTION ACT SNL 2002 cE-14.2
1. Name of Applicant: ____________________________________________________
2. Address: _____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. Contact Info: _________________
__________________
_________________
Email Address:_______________________________________________________
4. Has a Vendor Licence been held previously in this province? YES NO 
*If YES, Vendors Licence Number held previously was: ______________________
Both: 
6. Nature of business:
Retail:
Wholesale:
7. Name, address, and telephone number of person(s) who holds a Certified Pesticide
Vendor Licence with your company:
Certified Pesticide Vendor Licence Number: ___________________________
Name: __________________________________________________________
Address (If different than Question 2):
_______________________________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Contact Info: ________________
________________ ________________
8. Chemical and/or trade name, registration number under the Pest Control Products Act
(Canada) and formulation(s) of pesticide(s) proposed to be sold.
Note: If space is insufficient please attach additional sheets.
1
2
Chemical or Trade Name
PCP Number
Classification
Formulation
1 D = Domestic; C(I) = Commercial (Industrial); R = Restricted
M = Manufacturing
2 D = Dust; DF = Dry Flowable; EC = Emulsifiable Concentrate;
F
= Flowable; G = Granular;
P = Pellet;
S = Solution;
Sc = Sprayable Concentrate;
Sn = Active Solution; SP = Soluble Powders;
WDG = Water Dispersible Granules; WP = Wettable Powders;
WS = Water Soluble Concentrat
9. A fee of $ 375.00 in the form of a cheque or money order must be submitted with this
application. Please make the cheque or money order payable to the Newfoundland
Exchequer Account and write Revenue Account No.
on the
1760-500-57L0-2764
cheque or money order to facilitate processing. A receipt from Central Cashier
indicating that payment has been received will also be accepted. Cash payments will
not be accepted.
I hereby certify that the information provided in this application is accurate, to the best of
my knowledge.
Signature: _______________________ Position Title:___________________________
Date:
_______________________
This application including any copies of Certificates or Certified Vendor Licences must
be submitted to:
Pesticide Enforcement and Licensing Specialist
Personal & Confidential
Department of Municipal Affairs and Environment
Pesticides Control Section
P.O. Box 8700
St. John’s, NL
A1B 4J6
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