﻿<?xml version="1.0" encoding="utf-8"?><Regulation regulation-type="SOR" xml:lang="en" startdate="20060322"><Identification Code="id=&quot;&quot;"><LimsAuthority><Alpha>P-4</Alpha><AuthorityTitle>Patent Act</AuthorityTitle></LimsAuthority><InstrumentNumber>SOR/2005-143</InstrumentNumber><ConsolidationDate><Date><YYYY>2013</YYYY><MM>01</MM><DD>28</DD></Date></ConsolidationDate><LastModifiedDate><Date><YYYY>2005</YYYY><MM>11</MM><DD>25</DD></Date></LastModifiedDate><EnablingAuthority Code="id=&quot;&quot;,ea=&quot;&quot;"><XRefExternal reference-type="act">PATENT ACT</XRefExternal></EnablingAuthority><LongTitle Code="id=&quot;&quot;,lt=&quot;&quot;">Use of Patented Products for International Humanitarian Purposes Regulations</LongTitle><RegulationMakerOrder><RegulationMaker>P.C.</RegulationMaker><OrderNumber>2005-861</OrderNumber><Date><YYYY>2005</YYYY><MM>5</MM><DD>10</DD></Date></RegulationMakerOrder></Identification><Order Code="od=&quot;&quot;"><Provision format-ref="indent-1-0" language-align="yes" list-item="no" Code="od=&quot;&quot;,pv=&quot;&quot;,nb=&quot;1&quot;"><Text>Whereas, pursuant to subsection 21.08(2)<FootnoteRef idref="footnotea_e">a</FootnoteRef> of the <XRefExternal reference-type="act" link="P-4">Patent Act</XRefExternal>, the Governor in Council has considered the humanitarian and non-commercial reasons underlying the issuance of authorizations under subsection 21.04(1)<FootnoteRef>a</FootnoteRef> of that Act;</Text><Footnote id="footnotea_e" placement="page" status="official"><Label>a</Label><Text>S.C. 2004, c. 23, s. 1</Text></Footnote></Provision><Provision format-ref="indent-1-0" language-align="no" list-item="no" Code="od=&quot;&quot;,pv=&quot;&quot;,nb=&quot;2&quot;"><Text>Therefore, Her Excellency the Governor General in Council, on the recommendation of the Minister of Industry, pursuant to section 12<FootnoteRef idref="footnoteb_e">b</FootnoteRef> of the <XRefExternal reference-type="act" link="P-4">Patent Act</XRefExternal>, hereby makes the annexed <XRefExternal reference-type="regulation" link="SOR-2005-143">Use of Patented Products for International Humanitarian Purposes Regulations</XRefExternal>.</Text><Footnote id="footnoteb_e" placement="page" status="official"><Label>b</Label><Text>S.C. 1993, c. 15, s. 29</Text></Footnote></Provision></Order><Body><Heading Code="ga=&quot;s_1&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_1&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;1&quot;">INTERPRETATION</TitleText></Heading><Section Code="se=&quot;1&quot;"><Label>1.</Label><Text>In these Regulations, <DefinedTermEn>Act</DefinedTermEn> means the <XRefExternal reference-type="act" link="P-4">Patent Act</XRefExternal>.</Text></Section><Heading Code="ga=&quot;s_2&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_2&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;2&quot;">COMMUNICATIONS</TitleText></Heading><Section Code="se=&quot;2&quot;"><Label>2.</Label><Subsection Code="se=&quot;2&quot;,ss=&quot;1&quot;"><Label>(1)</Label><Text>Any correspondence and envelope that relate to an application under section 21.04 of the Act shall clearly indicate this fact. The correspondence shall be written in English or French and shall be addressed, together with the envelope, in English or French to the Commissioner.</Text></Subsection><Subsection Code="se=&quot;2&quot;,ss=&quot;2&quot;"><Label>(2)</Label><Text>Correspondence shall be delivered to the Patent Office by hand or by mail and</Text><Paragraph Code="se=&quot;2&quot;,ss=&quot;2&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if it is delivered during the ordinary business hours of the Patent Office, it is considered to be received by the Commissioner on the day of the delivery; and</Text></Paragraph><Paragraph Code="se=&quot;2&quot;,ss=&quot;2&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if it is delivered outside the ordinary business hours of the Patent Office, it is considered to be received on the next business day.</Text></Paragraph></Subsection></Section><Section Code="se=&quot;3&quot;"><Label>3.</Label><Subsection Code="se=&quot;3&quot;,ss=&quot;1&quot;"><Label>(1)</Label><Text>For the purposes of sections 21.01 to 21.2 of the Act, any correspondence to be sent to a patentee shall be sent to its representative in Canada, as shown in the records of the Patent Office or, if no representative has been appointed, to the patentee.</Text></Subsection><Subsection Code="se=&quot;3&quot;,ss=&quot;2&quot;"><Label>(2)</Label><Text>Any correspondence sent to the patentee's representative in Canada is deemed to have been received by the patentee.</Text></Subsection></Section><Heading Code="ga=&quot;s_4&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_4&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;3&quot;">APPLICATION FOR AUTHORIZATION</TitleText></Heading><Section Code="se=&quot;4&quot;"><Label>4.</Label><Text>For the purpose of subsection 21.04(2) of the Act, an application for authorization shall be in the form set out in Form 1 of the schedule and shall be signed by the applicant.</Text></Section><Heading Code="ga=&quot;s_5&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_5&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;4&quot;">SOLEMN OR STATUTORY DECLARATIONS</TitleText></Heading><Section Code="se=&quot;5&quot;"><Label>5.</Label><Subsection Code="se=&quot;5&quot;,ss=&quot;1&quot;"><Label>(1)</Label><Text>The solemn or statutory declaration referred to in paragraph 21.04(3)(<Emphasis style="italic">c</Emphasis>) of the Act shall be in the form set out in Form 2 of the schedule and shall be signed by the applicant.</Text></Subsection><Subsection Code="se=&quot;5&quot;,ss=&quot;2&quot;"><Label>(2)</Label><Text>The solemn or statutory declarations referred to in clauses 21.04(3)(<Emphasis style="italic">d</Emphasis>)(i)(A) and (B) and (ii)(A) and (B) of the Act shall be in the form set out in Forms 3, 4, 5 and 6, respectively, of the schedule and shall be signed by the applicant.</Text></Subsection><Subsection Code="se=&quot;5&quot;,ss=&quot;3&quot;"><Label>(3)</Label><Text>The solemn or statutory declarations referred to in clauses 21.04(3)(<Emphasis style="italic">d</Emphasis>)(iii)(A), (iv)(A) and (v)(A) of the Act shall be in the form set out in Form 7 of the schedule and shall be signed by the applicant.</Text></Subsection><Subsection Code="se=&quot;5&quot;,ss=&quot;4&quot;"><Label>(4)</Label><Text>The solemn or statutory declaration referred to in paragraph 21.16(1)(<Emphasis style="italic">b</Emphasis>) of the Act shall be in the form set out in Form 8 of the schedule and shall be signed by the holder of the authorization.</Text></Subsection></Section><Heading Code="ga=&quot;s_6&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_6&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;5&quot;">AUTHORIZATION</TitleText></Heading><Section Code="se=&quot;6&quot;"><Label>6.</Label><Text>For the purpose of subsection 21.05(1) of the Act, the authorization shall be in the form set out in Form 9 of the schedule.</Text></Section><Heading Code="ga=&quot;s_7&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_7&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;6&quot;">WEBSITE</TitleText></Heading><Section Code="se=&quot;7&quot;"><Label>7.</Label><Text>For the purpose of section 21.06 of the Act, the website of the holder of an authorization shall disclose the following information:</Text><Paragraph Code="se=&quot;7&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product named in the application is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>, the name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product, or if the pharmaceutical product is a medical device, the name of the medical device;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>the name of the country or WTO Member named in the application to which the pharmaceutical product is to be exported;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;c&quot;"><Label>(<Emphasis style="italic">c</Emphasis>)</Label><Text>if the country or WTO Member referred to in paragraph (<Emphasis style="italic">b</Emphasis>) is not itself the purchaser of the pharmaceutical product, the name of the person or entity — other than a governmental person or entity — referred to in paragraph 21.04(2)(<Emphasis style="italic">f</Emphasis>) of the Act, to which the product is to be sold, together with their postal address;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;d&quot;"><Label>(<Emphasis style="italic">d</Emphasis>)</Label><Text>the quantity of the pharmaceutical product that, under section 21.04 of the Act, has been authorized to be manufactured for export to the country or WTO Member referred to in paragraph (<Emphasis style="italic">b</Emphasis>);</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;e&quot;"><Label>(<Emphasis style="italic">e</Emphasis>)</Label><Text>the distinguishing features of the pharmaceutical product — including its colour if applicable — and of its label and packaging, as required by regulations made under the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;f&quot;"><Label>(<Emphasis style="italic">f</Emphasis>)</Label><Text>the name and postal address of the shipping agent and any other party that, to the knowledge of the holder of the authorization, will be handling the pharmaceutical product while it is in transit from Canada to the country or WTO Member referred to in paragraph (<Emphasis style="italic">b</Emphasis>);</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;g&quot;"><Label>(<Emphasis style="italic">g</Emphasis>)</Label><Text>if the consignee in the importing country or WTO Member is a person or entity other than the country or WTO Member referred to in paragraph (<Emphasis style="italic">b</Emphasis>), or the person or entity referred to in paragraph (<Emphasis style="italic">c</Emphasis>), as the case may be, the name and postal address of the consignee;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;h&quot;"><Label>(<Emphasis style="italic">h</Emphasis>)</Label><Text>the quantity of the pharmaceutical product contained in each shipment;</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;i&quot;"><Label>(<Emphasis style="italic">i</Emphasis>)</Label><Text>the export tracking number issued by the Minister of Health in respect of each shipment; and</Text></Paragraph><Paragraph Code="se=&quot;7&quot;,p1=&quot;j&quot;"><Label>(<Emphasis style="italic">j</Emphasis>)</Label><Text>the number of the bill of lading for each shipment.</Text></Paragraph></Section><Heading Code="ga=&quot;s_8&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_8&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;7&quot;">ROYALTIES</TitleText></Heading><Section Code="se=&quot;8&quot;"><Label>8.</Label><Subsection Code="se=&quot;8&quot;,ss=&quot;1&quot;"><Label>(1)</Label><Text>In this section, <DefinedTermEn>Index</DefinedTermEn> means the Human Development Index developed and maintained by the United Nations Development Programme.</Text></Subsection><Subsection Code="se=&quot;8&quot;,ss=&quot;2&quot;"><Label>(2)</Label><Text>For the purpose of subsection 21.08(1) of the Act, the events on the occurrence of which a royalty is required to be paid, and the manner of determining the royalty, are as follows:</Text><Paragraph Code="se=&quot;8&quot;,ss=&quot;2&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the total quantity of the pharmaceutical product that is authorized to be manufactured and exported is exported in a single shipment, the amount of the royalty determined in accordance with subsection (4) or (6), as the circumstances require, shall be paid in full within 45 days after the date of the export notice provided under section 21.07 of the Act; and</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;2&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the quantity of the pharmaceutical product that is authorized to be manufactured and exported is exported in a series of shipments, a royalty shall be paid within 45 days after the date of the export notice provided under section 21.07 of the Act in an amount for a shipment that is the same proportion of the full amount of the royalty determined in accordance with subsection (4) or (6), as the circumstances require, as the quantity of the pharmaceutical product exported in the shipment is of the quantity of the pharmaceutical product that has been authorized to be manufactured and exported.</Text></Paragraph></Subsection><Subsection Code="se=&quot;8&quot;,ss=&quot;3&quot;"><Label>(3)</Label><Text>If the name of the country or WTO Member to which an authorization relates appears on the Index, the rate for calculating the royalty that is required to be paid to the patentee or to each of the patentees, as the case may be, in respect of the authorization shall be determined by</Text><Paragraph Code="se=&quot;8&quot;,ss=&quot;3&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>adding 1 to the total number of countries listed on the Index;</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;3&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>subtracting from the sum determined under paragraph (<Emphasis style="italic">a</Emphasis>) the numerical rank on the Index of the country or WTO Member to which the pharmaceutical product is to be exported;</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;3&quot;,p1=&quot;c&quot;"><Label>(<Emphasis style="italic">c</Emphasis>)</Label><Text>dividing the difference determined under paragraph (<Emphasis style="italic">b</Emphasis>) by the total number of countries listed on the Index; and</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;3&quot;,p1=&quot;d&quot;"><Label>(<Emphasis style="italic">d</Emphasis>)</Label><Text>multiplying the quotient determined under paragraph (<Emphasis style="italic">c</Emphasis>) by 0.04.</Text></Paragraph></Subsection><Subsection Code="se=&quot;8&quot;,ss=&quot;4&quot;"><Label>(4)</Label><Text>If the name of the country or WTO Member to which an authorization relates appears on the Index, the amount of royalty payable to the patentee or to each of the patentees, as the case may be, shall be determined</Text><Paragraph Code="se=&quot;8&quot;,ss=&quot;4&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>when there is only one patentee, by multiplying the total monetary value, expressed in Canadian currency, of the agreement pertaining to the pharmaceutical product to be manufactured, sold and exported under the authorization by the royalty rate determined in accordance with subsection (3); and</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;4&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>when there is more than one patentee, by dividing the amount determined under paragraph (<Emphasis style="italic">a</Emphasis>) by the number of patentees.</Text></Paragraph></Subsection><Subsection Code="se=&quot;8&quot;,ss=&quot;5&quot;"><Label>(5)</Label><Text>If the name of the country or WTO Member to which an authorization relates does not appear on the Index, the rate for calculating the royalty that is required to be paid to the patentee or to each of the patentees, as the case may be, in respect of the applicable authorization shall be determined by</Text><Paragraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>adding 1 to the total number of countries listed on the Index;</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>subtracting from the sum determined under paragraph (<Emphasis style="italic">a</Emphasis>) the average</Text><Subparagraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;b&quot;,p2=&quot;i&quot;"><Label>(i)</Label><Text>in the case of a country or WTO Member to which the pharmaceutical product is to be exported and whose name appears in Schedule 2 or 3 to the Act, of the numerical ranks on the Index of all of the countries and WTO Members whose names appear both on the Index and in the same Schedule to the Act as the country or WTO Member to which the pharmaceutical product is to be exported,</Text></Subparagraph><Subparagraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;b&quot;,p2=&quot;ii&quot;"><Label>(ii)</Label><Text>in the case of a country — other than a WTO Member — to which the pharmaceutical product is to be exported and whose name appears in Schedule 4 to the Act, of the numerical ranks on the Index of all of the WTO Members whose names appear both on the Index and in Schedule 3 to the Act, and</Text></Subparagraph><Subparagraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;b&quot;,p2=&quot;iii&quot;"><Label>(iii)</Label><Text>in the case of a WTO Member to which the pharmaceutical product is to be exported and whose name appears in Schedule 4 to the Act, of the numerical ranks on the Index of all of the WTO Members whose names appear both on the Index and in Schedule 4 to the Act;</Text></Subparagraph></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;c&quot;"><Label>(<Emphasis style="italic">c</Emphasis>)</Label><Text>dividing the difference determined under paragraph (<Emphasis style="italic">b</Emphasis>) by the total number of countries listed on the Index; and</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;5&quot;,p1=&quot;d&quot;"><Label>(<Emphasis style="italic">d</Emphasis>)</Label><Text>multiplying the quotient determined under paragraph (<Emphasis style="italic">c</Emphasis>) by 0.04.</Text></Paragraph></Subsection><Subsection Code="se=&quot;8&quot;,ss=&quot;6&quot;"><Label>(6)</Label><Text>If the name of the country or WTO Member to which an authorization relates does not appear on the Index, the amount of royalty payable to the patentee or to each of the patentees, as the case may be, shall be determined</Text><Paragraph Code="se=&quot;8&quot;,ss=&quot;6&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>when there is only one patentee, by multiplying the total monetary value, expressed in Canadian currency, of the agreement pertaining to the pharmaceutical product to be manufactured, sold and exported under the authorization by the royalty rate determined in accordance with subsection (5); and</Text></Paragraph><Paragraph Code="se=&quot;8&quot;,ss=&quot;6&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>when there is more than one patentee, by dividing the amount determined under paragraph (<Emphasis style="italic">a</Emphasis>) by the number of patentees.</Text></Paragraph></Subsection></Section><Heading Code="ga=&quot;s_9&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_9&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;8&quot;">RENEWAL APPLICATION</TitleText></Heading><Section Code="se=&quot;9&quot;"><Label>9.</Label><Text>For the purpose of section 21.12 of the Act, an application for the renewal of an authorization shall be in the form set out in Form 10 of the schedule and shall be signed by the holder of the authorization.</Text></Section><Heading Code="ga=&quot;s_10&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_10&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;9&quot;">RENEWAL OF AUTHORIZATION</TitleText></Heading><Section Code="se=&quot;10&quot;"><Label>10.</Label><Text>The renewal of an authorization by the Commissioner under section 21.12 of the Act shall be in the form set out in Form 11 of the schedule.</Text></Section><Heading Code="ga=&quot;s_11&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_11&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;10&quot;">PRODUCT PRICE PUBLICATIONS</TitleText></Heading><Section Code="se=&quot;11&quot;"><Label>11.</Label><Text>For the purpose of paragraph (<Emphasis style="italic">b</Emphasis>) of the definition <DefinedTermEn>average price</DefinedTermEn> in subsection 21.17(6) of the Act, the publications reporting the prices in Canada of pharmaceutical products sold by or with the consent of the patentee that are equivalent to the pharmaceutical product to which an authorization under section 21.04 of the Act relates are the following:</Text><Paragraph Code="se=&quot;11&quot;,p1=&quot;a&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>the <XRefExternal reference-type="other">Ontario Drug Benefit Formulary</XRefExternal>, as amended from time to time;</Text></Paragraph><Paragraph Code="se=&quot;11&quot;,p1=&quot;b&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>the <XRefExternal reference-type="other">Drug Formulary</XRefExternal> published by the Régie de l'assurance maladie du Québec, as amended from time to time; and</Text></Paragraph><Paragraph Code="se=&quot;11&quot;,p1=&quot;c&quot;"><Label>(<Emphasis style="italic">c</Emphasis>)</Label><Text>the <XRefExternal reference-type="other">PPS® Pharma Publication</XRefExternal> published by Total Pricing Systems Inc., as amended from time to time.</Text></Paragraph></Section><Heading type="transitional" Code="ga=&quot;s_12&quot;,h1=&quot;&quot;" level="1"><TitleText Code="ga=&quot;s_12&quot;,h1=&quot;&quot;,t1=&quot;&quot;,nb=&quot;11&quot;">COMING INTO FORCE</TitleText></Heading><Section type="transitional" Code="se=&quot;12&quot;"><Label>12.<FootnoteRef idref="footnotestar_e">*</FootnoteRef></Label><Text>These Regulations come into force on the day on which <XRefExternal reference-type="act">An Act to amend the Patent Act and the Food and Drugs Act (The Jean Chrétien Pledge to Africa)</XRefExternal>, being chapter 23 of the Statutes of Canada, 2004, comes into force.</Text><Footnote id="footnotestar_e" placement="page" status="official"><Label>*</Label><Text><Emphasis style="regular">[Regulations in force May 14, 2005, <Emphasis style="italic">see</Emphasis> SI/2005-46.]</Emphasis></Text></Footnote></Section></Body><Schedule Code="sc=&quot;&quot;,nb=&quot;1&quot;"><ScheduleFormHeading Code="sc=&quot;&quot;,nb=&quot;1&quot;,sf=&quot;&quot;"><Label>SCHEDULE</Label></ScheduleFormHeading><FormGroup><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;3&quot;"><Text>FORM 1</Text></Provision><Provision format-ref="centered" language-align="yes" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;4&quot;"><Text><Emphasis style="italic">(Section 4)</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;5&quot;"><Text>APPLICATION FOR AUTHORIZATION UNDER SECTION 21.04 OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;6&quot;"><Label>1.</Label><Text>The undersigned hereby applies for an authorization under section 21.04 of the Act.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;7&quot;"><Label>2.</Label><Text>The pharmaceutical product that the undersigned intends to manufacture and sell for export under the authorization is</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;7&quot;,pv=&quot;&quot;,nb=&quot;8&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal><LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;7&quot;,pv=&quot;&quot;,nb=&quot;8&quot;,pv=&quot;&quot;,nb=&quot;9&quot;"><Text><Leader leader="solid" length="37pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;7&quot;,pv=&quot;&quot;,nb=&quot;10&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;7&quot;,pv=&quot;&quot;,nb=&quot;10&quot;,pv=&quot;&quot;,nb=&quot;11&quot;"><Text>(<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>).</Text></Provision></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;12&quot;"><Label>3.</Label><Text>The maximum quantity of the pharmaceutical product that the undersigned intends to manufacture and sell for export under the authorization is <LeaderRightJustified leader="solid" />.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;13&quot;"><Label>4.</Label><Text>For each patented invention to which the application relates, the name(s) of the patentee(s) of the invention, the name(s) and postal address(es) of the representative(s) of the patentee(s) or, if no representative has been appointed, the postal address(es) of the patentee(s), and the patent number(s) issued in respect of the invention are as follows:</Text><TableGroup bilingual="no" orientation="portrait" spanlanguages="no" spanmarginalnotecol="no"><table frame="topbot"><tgroup cols="4"><colspec colname="1" colwidth="10.10*" htmlwidth="10%" /><colspec colname="2" colwidth="30.05*" htmlwidth="30%" /><colspec colname="3" colwidth="29.81*" htmlwidth="30%" /><colspec colname="4" colwidth="30.05*" htmlwidth="30%" /><thead><row rowsep="1" topdouble="yes" topmarginspacing="4"><entry colname="1" colsep="0" valign="top" id="t4421h0"></entry><entry colname="2" colsep="0" valign="bottom" id="t4421h1">Name of Patentee</entry><entry colname="3" colsep="0" valign="top" id="t4421h2">Name and Address of <Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;13&quot;,pv=&quot;&quot;,nb=&quot;14&quot;"><Text>Patentee's Representative or</Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;13&quot;,pv=&quot;&quot;,nb=&quot;15&quot;"><Text>Address of Patentee</Text></Provision></entry><entry colname="4" colsep="0" valign="bottom" id="t4421h3">Patent Number</entry></row><row height="10pt" rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" valign="top" id="t4421h4">(<Emphasis style="italic">a</Emphasis>)</entry><entry colname="2" colsep="0" valign="top" id="t4421h5" headers="t4421h1"></entry><entry colname="3" colsep="0" valign="top" id="t4421h6" headers="t4421h2"></entry><entry colname="4" colsep="0" valign="top" id="t4421h7" headers="t4421h3"></entry></row></thead><tbody><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4421h4">(<Emphasis style="italic">b</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4421h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4421h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4421h3"></entry></row><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4421h4">(<Emphasis style="italic">c</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4421h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4421h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4421h3"></entry></row><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4421h4">(<Emphasis style="italic">d</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4421h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4421h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4421h3"></entry></row></tbody></tgroup></table></TableGroup></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;16&quot;"><Label>5.</Label><Text>The name of the WTO Member or country that has notified, respectively, the TRIPS Council or the Government of Canada in writing of its requirement for the pharmaceutical product named in the application, and to which the pharmaceutical product is to be exported, is<LeaderRightJustified leader="solid" />.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;17&quot;"><Label>6.</Label><Text>The name, postal address and telephone number of the person or entity referred to in paragraph 21.04(2)(<Emphasis style="italic">f</Emphasis>) of the Act, to which the pharmaceutical product is to be sold, are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;17&quot;,pv=&quot;&quot;,nb=&quot;18&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;17&quot;,pv=&quot;&quot;,nb=&quot;19&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;17&quot;,pv=&quot;&quot;,nb=&quot;20&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;17&quot;,pv=&quot;&quot;,nb=&quot;21&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;22&quot;"><Label>7.</Label><Text>For the purpose of subsection 21.06(1) of the Act, the website address of the undersigned is <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;"><Label>8.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;24&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;25&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;26&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;27&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;28&quot;"><Text>Dated at <Leader leader="solid" length="6pc" /> the <Leader leader="solid" length="6pc" /> day of <Leader leader="solid" length="6pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;29&quot;"><Text><Leader leader="solid" length="8.2pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;23&quot;,pv=&quot;&quot;,nb=&quot;30&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;31&quot;"><Text>FORM 2</Text></Provision><Provision format-ref="centered" language-align="yes" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;32&quot;"><Text><Emphasis style="italic">(Subsection 5(1))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;33&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER PARAGRAPH 21.04(3)(<Emphasis style="italic">c</Emphasis>) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;34&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;35&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;36&quot;"><Text><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;37&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;37&quot;,pv=&quot;&quot;,nb=&quot;38&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;37&quot;,pv=&quot;&quot;,nb=&quot;39&quot;"><Text>(<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;40&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;40&quot;,pv=&quot;&quot;,nb=&quot;41&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;40&quot;,pv=&quot;&quot;,nb=&quot;42&quot;"><Text>(<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of applicant)</Emphasis> hereby declares, in accordance with paragraph 21.04(3)(<Emphasis style="italic">c</Emphasis>) of the Act, that on <Leader leader="solid" length="10pc" /><Emphasis style="italic">(date)</Emphasis>, being at least 30 days before the date of filing of the application for an authorization under section 21.04 of the Act, the undersigned</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;44&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>sought from the patentee or, if there is more than one, from each of the patentees, namely, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;45&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;46&quot;"><Text><Emphasis style="italic">(name(s) of the patentee(s))</Emphasis>, by certified or registered mail addressed to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;47&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;48&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;49&quot;"><Text><Emphasis style="italic">(name(s) and postal address(es) of the patentee(s) or the representative(s) of the patentee(s), if any)</Emphasis>, a licence to manufacture and sell the pharmaceutical product for export to the country or WTO Member named in the application on reasonable terms and conditions and that such efforts have not been successful; and</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;43&quot;,pv=&quot;&quot;,nb=&quot;50&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>provided the patentee, or each of the patentees, as the case may be, by certified or registered mail, in the written request for a licence, with the information that is in all material respects identical to the information required under paragraphs 21.04(2)(<Emphasis style="italic">a</Emphasis>) to (<Emphasis style="italic">g</Emphasis>) of the Act.</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;52&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;53&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;54&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;55&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;56&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;57&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;51&quot;,pv=&quot;&quot;,nb=&quot;58&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;59&quot;"><Text>FORM 3</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;60&quot;"><Text><Emphasis style="italic">(Subsection 5(2))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;61&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER CLAUSE 21.04(3)(<Emphasis style="italic">d</Emphasis>)(i)(A) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;63&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of WTO Member)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;64&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;64&quot;,pv=&quot;&quot;,nb=&quot;65&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;64&quot;,pv=&quot;&quot;,nb=&quot;66&quot;"><Text><Leader leader="solid" length="15pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;67&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;68&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;62&quot;,pv=&quot;&quot;,nb=&quot;69&quot;"><Text><Leader leader="solid" length="15pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;70&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="15pc" /><Emphasis style="italic">(name of applicant)</Emphasis> hereby declares, in accordance with clause 21.04(3)(<Emphasis style="italic">d</Emphasis>)(i)(A) of the Act, that the pharmaceutical product to which the application relates</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;70&quot;,pv=&quot;&quot;,nb=&quot;71&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>is the pharmaceutical product specified in the notice in writing that the WTO Member has provided to the TRIPS Council; and</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;70&quot;,pv=&quot;&quot;,nb=&quot;72&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>is not patented in that WTO Member.</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;74&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;75&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;76&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;77&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;78&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;79&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;73&quot;,pv=&quot;&quot;,nb=&quot;80&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;81&quot;"><Text>FORM 4</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;82&quot;"><Text><Emphasis style="italic">(Subsection 5(2))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;83&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER CLAUSE 21.04(3)(<Emphasis style="italic">d</Emphasis>)(i)(B) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;85&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;86&quot;"><Text><Emphasis style="italic">(name of WTO Member)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;87&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;87&quot;,pv=&quot;&quot;,nb=&quot;88&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;87&quot;,pv=&quot;&quot;,nb=&quot;89&quot;"><Text><Leader leader="solid" length="15pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;90&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;84&quot;,pv=&quot;&quot;,nb=&quot;91&quot;"><Text><Leader leader="solid" length="15pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>)</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;92&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of applicant)</Emphasis> hereby declares, in accordance with clause 21.04(3)(<Emphasis style="italic">d</Emphasis>)(i)(B) of the Act, that the pharmaceutical product to which the application relates is the pharmaceutical product that is specified in the notice in writing that the WTO Member has provided to the TRIPS Council.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;94&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;95&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;96&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;97&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;98&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;99&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;93&quot;,pv=&quot;&quot;,nb=&quot;100&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;101&quot;"><Text>FORM 5</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;102&quot;"><Text><Emphasis style="italic">(Subsection 5(2))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;103&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER CLAUSE 21.04(3)(<Emphasis style="italic">d</Emphasis>)(ii)(A) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;105&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;106&quot;"><Text><Emphasis style="italic">(name of country)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;107&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;107&quot;,pv=&quot;&quot;,nb=&quot;108&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;107&quot;,pv=&quot;&quot;,nb=&quot;109&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;110&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;110&quot;,pv=&quot;&quot;,nb=&quot;111&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;104&quot;,pv=&quot;&quot;,nb=&quot;112&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;113&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of applicant)</Emphasis> hereby declares, in accordance with clause 21.04(3)(<Emphasis style="italic">d</Emphasis>)(ii)(A) of the Act, that the pharmaceutical product to which the application relates</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;113&quot;,pv=&quot;&quot;,nb=&quot;114&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>is the pharmaceutical product specified in the notice in writing that the country has provided to the Government of Canada; and</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;113&quot;,pv=&quot;&quot;,nb=&quot;115&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>is not patented in that country.</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;117&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;118&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;119&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;120&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;121&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;122&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;116&quot;,pv=&quot;&quot;,nb=&quot;123&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;124&quot;"><Text>FORM 6</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;125&quot;"><Text><Emphasis style="italic">(Subsection 5(2))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;126&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER CLAUSE 21.04(3)(<Emphasis style="italic">d</Emphasis>)(ii)(B) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;128&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;129&quot;"><Text><Emphasis style="italic">(name of country)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;130&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;130&quot;,pv=&quot;&quot;,nb=&quot;131&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;130&quot;,pv=&quot;&quot;,nb=&quot;132&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">(name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product)</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;133&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;133&quot;,pv=&quot;&quot;,nb=&quot;134&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;127&quot;,pv=&quot;&quot;,nb=&quot;135&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>)</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;136&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="15pc" /><Emphasis style="italic">(name of applicant)</Emphasis> declares, in accordance with clause 21.04(3)(<Emphasis style="italic">d</Emphasis>)(ii)(B) of the Act, that the pharmaceutical product to which the application relates is the pharmaceutical product that is specified in the notice in writing that the country has provided to the Government of Canada.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;138&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;139&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;140&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;141&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;142&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;143&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;137&quot;,pv=&quot;&quot;,nb=&quot;144&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;145&quot;"><Text>FORM 7</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;146&quot;"><Text><Emphasis style="italic">(Subsection 5(3))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;147&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER CLAUSE 21.04(3)(<Emphasis style="italic">d</Emphasis>)(iii)(A), (iv)(A) AND (v)(A) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;"><Text>In the matter of an application by <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;149&quot;"><Text><Emphasis style="italic">(name of applicant)</Emphasis> for export to <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;150&quot;"><Text><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;151&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;151&quot;,pv=&quot;&quot;,nb=&quot;152&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;151&quot;,pv=&quot;&quot;,nb=&quot;153&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;154&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;154&quot;,pv=&quot;&quot;,nb=&quot;155&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;148&quot;,pv=&quot;&quot;,nb=&quot;156&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;157&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of applicant)</Emphasis> hereby declares, in accordance with clause 21.04(3)(<Emphasis style="italic">d</Emphasis>)(iii)(A), (iv)(A) or (v)(A) of the Act, as the case may be, that the pharmaceutical product to which the application relates is not patented in the country or WTO Member.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;159&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;160&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;161&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;162&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;163&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;164&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;158&quot;,pv=&quot;&quot;,nb=&quot;165&quot;"><Text>Signature of applicant</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;166&quot;"><Text>FORM 8</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;167&quot;"><Text><Emphasis style="italic">(Subsection 5(4))</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;168&quot;"><Text>SOLEMN OR STATUTORY DECLARATION UNDER PARAGRAPH 21.16(1)(<Emphasis style="italic">b</Emphasis>) OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;"><Text>In the matter of authorization number <Leader leader="solid" length="6pc" /> granted on <Leader leader="solid" length="6pc" /> (<Emphasis style="italic">date</Emphasis>) to <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of holder of authorization)</Emphasis> for export to <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;170&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;170&quot;,pv=&quot;&quot;,nb=&quot;171&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;170&quot;,pv=&quot;&quot;,nb=&quot;172&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;170&quot;,pv=&quot;&quot;,nb=&quot;173&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;174&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;174&quot;,pv=&quot;&quot;,nb=&quot;175&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;169&quot;,pv=&quot;&quot;,nb=&quot;176&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;177&quot;"><Label>1.</Label><Text>The undersigned <Leader leader="solid" length="10pc" /><Emphasis style="italic">(name of holder of authorization)</Emphasis> hereby declares, in accordance with paragraph 21.16(1)(<Emphasis style="italic">b</Emphasis>) of the Act, that</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;177&quot;,pv=&quot;&quot;,nb=&quot;178&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>the total monetary value of the agreement, expressed in Canadian currency, as it relates to the pharmaceutical product authorized to be manufactured and sold is $ <Leader leader="solid" length="6pc" />; and</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;177&quot;,pv=&quot;&quot;,nb=&quot;179&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>the number of units of the pharmaceutical product to be sold under the terms of the agreement is <LeaderRightJustified leader="solid" />.</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;"><Label>2.</Label><Text>The name, postal address and telephone number of the undersigned are as follows:</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;181&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;182&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;183&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;184&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;185&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;186&quot;"><Text><Leader leader="solid" length="13pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;180&quot;,pv=&quot;&quot;,nb=&quot;187&quot;"><Text>Signature of holder of authorization</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;188&quot;"><Text>FORM 9</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;189&quot;"><Text><Emphasis style="italic">(Section 6)</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;190&quot;"><Text>AUTHORIZATION UNDER SECTION 21.04 OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;"><Text>In the matter of application for authorization number <Leader leader="solid" length="8pc" /> by <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of applicant)</Emphasis> for export to <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;192&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;192&quot;,pv=&quot;&quot;,nb=&quot;193&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;192&quot;,pv=&quot;&quot;,nb=&quot;194&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;195&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;195&quot;,pv=&quot;&quot;,nb=&quot;196&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;191&quot;,pv=&quot;&quot;,nb=&quot;197&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>); or</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;198&quot;"><Label>1.</Label><Text>I hereby authorize <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of applicant)</Emphasis>, whose postal address is <Leader leader="solid" length="8pc" />, to make, construct and use, the patented invention(s) identified in patent number(s) <Leader leader="solid" length="8pc" /> solely for purposes directly related to the manufacture of the above-mentioned pharmaceutical product, and to sell it for export to the above-mentioned country or WTO Member.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;199&quot;"><Label>2.</Label><Text>The quantity of the pharmaceutical product authorized to be manufactured by this authorization is <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;200&quot;"><Label>3.</Label><Text>In accordance with section 21.09 of the Act, this authorization is valid for a period of two years beginning on the date shown below.</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;200&quot;,pv=&quot;&quot;,nb=&quot;201&quot;"><Text>Granted at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;200&quot;,pv=&quot;&quot;,nb=&quot;202&quot;"><Text><Leader leader="solid" length="14pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;200&quot;,pv=&quot;&quot;,nb=&quot;203&quot;"><Text>Signature of Commissioner of Patents</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;204&quot;"><Text>FORM 10</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;205&quot;"><Text><Emphasis style="italic">(Section 9)</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;206&quot;"><Text>APPLICATION FOR RENEWAL OF AUTHORIZATION UNDER SECTION 21.12 OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;"><Text>In the matter of an application for renewal of authorization by <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of applicant)</Emphasis> for export to <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;,pv=&quot;&quot;,nb=&quot;208&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;,pv=&quot;&quot;,nb=&quot;208&quot;,pv=&quot;&quot;,nb=&quot;209&quot;"><Text>(<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;,pv=&quot;&quot;,nb=&quot;210&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;,pv=&quot;&quot;,nb=&quot;210&quot;,pv=&quot;&quot;,nb=&quot;211&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;207&quot;,pv=&quot;&quot;,nb=&quot;212&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text></Provision></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;213&quot;"><Label>1.</Label><Text>The undersigned, whose postal address and telephone number are <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;214&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;215&quot;"><Text><Leader leader="solid" length="4pc" />, hereby applies for a renewal of authorization number <Leader leader="solid" length="6pc" /> that was granted on <Leader leader="solid" length="10pc" /><Emphasis style="italic">(date)</Emphasis> authorizing the making, construction and use of the patented invention(s) identified in the patent numbers below, solely for purposes directly related to the manufacture of <Leader leader="solid" length="10pc" /><Emphasis style="italic">(unexported quantity)</Emphasis> of the above-mentioned pharmaceutical product and its sale for export to the above-mentioned country or WTO Member.</Text></Provision><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;"><Label>2.</Label><Text>For each patented invention to which the application for renewal relates, the name(s) of the patentee(s) of the invention, the name(s) and postal address(es) of the representative(s) of the patentee(s) or, if no representative has been appointed, the postal address(es) of the patentee(s), and the patent number(s) issued in respect of the invention are as follows:</Text><TableGroup bilingual="no" orientation="portrait" spanlanguages="no" spanmarginalnotecol="no"><table frame="topbot"><tgroup cols="4"><colspec colname="1" colwidth="10.10*" htmlwidth="10%" /><colspec colname="2" colwidth="30.05*" htmlwidth="30%" /><colspec colname="3" colwidth="29.81*" htmlwidth="30%" /><colspec colname="4" colwidth="30.05*" htmlwidth="30%" /><thead><row rowsep="1" topdouble="yes" topmarginspacing="4"><entry colname="1" colsep="0" valign="top" id="t4422h0"></entry><entry colname="2" colsep="0" valign="bottom" id="t4422h1">Name of Patentee</entry><entry colname="3" colsep="0" valign="top" id="t4422h2">Name and Address of <Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;217&quot;"><Text>Patentee's Representative or</Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;218&quot;"><Text>Address of Patentee</Text></Provision></entry><entry colname="4" colsep="0" valign="bottom" id="t4422h3">Patent Number</entry></row><row height="10pt" rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" valign="top" id="t4422h4">(<Emphasis style="italic">a</Emphasis>)</entry><entry colname="2" colsep="0" valign="top" id="t4422h5" headers="t4422h1"></entry><entry colname="3" colsep="0" valign="top" id="t4422h6" headers="t4422h2"></entry><entry colname="4" colsep="0" valign="top" id="t4422h7" headers="t4422h3"></entry></row></thead><tbody><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4422h4">(<Emphasis style="italic">b</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4422h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4422h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4422h3"></entry></row><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4422h4">(<Emphasis style="italic">c</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4422h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4422h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4422h3"></entry></row><row rowsep="0" topmarginspacing="4"><entry colname="1" colsep="0" rowsep="0" valign="top" headers="t4422h4">(<Emphasis style="italic">d</Emphasis>)</entry><entry colname="2" colsep="0" rowsep="0" valign="top" headers="t4422h1"></entry><entry colname="3" colsep="0" rowsep="0" valign="top" headers="t4422h2"></entry><entry colname="4" colsep="0" rowsep="0" valign="top" headers="t4422h3"></entry></row></tbody></tgroup></table></TableGroup><Provision format-ref="indent-1-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;219&quot;"><Label>3.</Label><Text>The undersigned hereby certifies that</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;219&quot;,pv=&quot;&quot;,nb=&quot;220&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>the quantities of the pharmaceutical product that were authorized under authorization number <Leader leader="solid" length="8pc" /> to be manufactured and sold for export under section 21.04 of the Act were not or will not be exported before the authorization ceases to be valid; and</Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;219&quot;,pv=&quot;&quot;,nb=&quot;221&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>the undersigned has complied with the terms of the authorization and the requirements of sections 21.06 to 21.08 of the Act.</Text></Provision></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;222&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;223&quot;"><Text><Leader leader="solid" length="8pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;224&quot;"><Text>Signature of applicant</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;225&quot;"><Text>Sworn before me this <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;226&quot;"><Text><Leader leader="solid" length="12pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;216&quot;,pv=&quot;&quot;,nb=&quot;227&quot;"><Text>Signature of Commissioner for Oaths</Text></Provision></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;228&quot;"><Text>FORM 11</Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;229&quot;"><Text><Emphasis style="italic">(Section 10)</Emphasis></Text></Provision><Provision format-ref="centered" language-align="yes" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;230&quot;"><Text>RENEWAL OF AUTHORIZATION UNDER SECTION 21.12 OF THE PATENT ACT</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;"><Text>In the matter of an application for a renewal of an authorization by <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of applicant)</Emphasis> for export to <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of country or WTO Member)</Emphasis> of the following pharmaceutical product:</Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;232&quot;"><Label>(<Emphasis style="italic">a</Emphasis>)</Label><Text>if the pharmaceutical product is a drug as defined in section 2 of the <XRefExternal reference-type="act" link="F-27">Food and Drugs Act</XRefExternal>: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;232&quot;,pv=&quot;&quot;,nb=&quot;233&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;232&quot;,pv=&quot;&quot;,nb=&quot;234&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act and, if applicable, the strength, dosage form and route of administration of the pharmaceutical product</Emphasis>); or</Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;235&quot;"><Label>(<Emphasis style="italic">b</Emphasis>)</Label><Text>if the pharmaceutical product is a medical device: <LeaderRightJustified leader="solid" /></Text><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;235&quot;,pv=&quot;&quot;,nb=&quot;236&quot;"><Text><LeaderRightJustified leader="solid" /></Text></Provision></Provision><Provision format-ref="indent-1-1" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;237&quot;"><Text><Leader leader="solid" length="10pc" /> (<Emphasis style="italic">name of the pharmaceutical product as set out in Schedule 1 to the Act, its class, and its identifier within the meaning of section 1 of the</Emphasis><XRefExternal reference-type="regulation" link="SOR-98-282">Medical Devices Regulations</XRefExternal>);</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;231&quot;,pv=&quot;&quot;,nb=&quot;237&quot;,pv=&quot;&quot;,nb=&quot;238&quot;"><Text>And in the matter of authorization number <Leader leader="solid" length="8pc" /> that was granted in accordance with section 21.04 of the Act on <Leader leader="solid" length="8pc" /><Emphasis style="italic">(date)</Emphasis> to make, construct and use the patented invention(s) identified in patent number(s) <Leader leader="solid" length="8pc" /> solely for purposes directly related to the manufacture of the quantity remaining to be shipped <Leader leader="solid" length="8pc" /><Emphasis style="italic">(quantity)</Emphasis> of the above-mentioned pharmaceutical product, and to sell it for export to <Leader leader="solid" length="8pc" /><Emphasis style="italic">(name of country or WTO Member)</Emphasis>;</Text></Provision></Provision></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;239&quot;"><Text>And whereas the applicant has not yet manufactured and exported the above-noted quantity of the pharmaceutical product on the date of its application for renewal;</Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;240&quot;"><Text>I hereby renew the above-mentioned authorization in accordance with section 21.12 of the Act.</Text><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;240&quot;,pv=&quot;&quot;,nb=&quot;241&quot;"><Text>Dated at <Leader leader="solid" length="8pc" /> the <Leader leader="solid" length="8pc" /> day of <Leader leader="solid" length="8pc" />, <LeaderRightJustified leader="solid" /></Text></Provision><Provision format-ref="indent-0-0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;240&quot;,pv=&quot;&quot;,nb=&quot;242&quot;"><Text><Leader leader="solid" length="14pc" /></Text></Provision><Provision format-ref="indent-0-0" topmarginspacing="0" Code="sc=&quot;&quot;,nb=&quot;1&quot;,pv=&quot;&quot;,nb=&quot;240&quot;,pv=&quot;&quot;,nb=&quot;243&quot;"><Text>Signature of Commissioner of Patents</Text></Provision></Provision></FormGroup></Schedule></Regulation>