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Under the provisions of the Controlled Drugs and Substances Act (CDSA) and the Precursor Control Regulations (PCR), the chemical product(s) being purchased is/are scheduled as a Class A precursor, in Schedule VI, Part I of the CDSA, and could be used in the clandestine production of controlled substances. In accordance with section 8 of the PCR, a licensed dealer must obtain a signed and dated end-use declaration prior to selling or providing a Class A precursor to a person who is not a licensed dealer when the quantity or package size is more than the maximum amount specified in the schedule to the PCR.

LICENSED DEALER

Licensed Dealer Name
RENDE INC.
Address
3100 Ridgeway Dr, Unit 23, Mississauga, Ontario, L5L5M5
Telephone Number
(905)606-0222
Facsimile Number

PRECURSOR

Name of Product(s)
Ma Huang/Xiao Qing Long Tang/Ge Gen Tang/Qing Bi Tang/Fang Feng Tong Sheng San/Gui Zhi Shao Yao Zhi Mu Tang/Ma Huang Fu Zi Xi Xin Tang/Ma Xing Shi Gan Tang/Wu JiSan/Wu Yao Shun Qi San/Yi Yi Ren Tang/Ma Huang Tang/Ding Chuan Tang
Precursor
Ephedrine
Description of End-Use(s)
TCM Prescription Dispensing

END USER

Name
(Including company or institution)
Address
Telephone Number
Facsimile Number
I meet the criteria set forth in section 5 of the PCR and am therefore exempted from the license requirement to sell/provide a Class A precursor. I hereby certify that the information provided in this End-Use Declaration is correct and complete, to the best of my knowledge, and in accordance with the provisions of the Controlled Drugs and Substances Act and the Precursor Control Regulations.

Signature:

Date:

2019-11-18

Please Sign At The Pad Below

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