Form R Application For Renewal Of Authorization To Possess Medical Marihuana The Medical Marijuana Mission (Page 2 of 3) in pdf

Form R Application For Renewal Of Authorization To Possess Medical Marihuana The Medical Marijuana Mission Page 2

R1 Applicant’s Information

o Mrs. o Miss o Ms. o Mr.

Print Name

Applicant’s full name:

last

first

middle

Date of Birth:

day

month

year

Gender:

Address:

Apartment Number:

City:

Province:

Postal Code:

Telephone: (

)

Fax:

(

)

E-mail:

If no street address is available, please provide lot and concession number:

Lot Number:

Concession Number:

Mailing Address (if different from above):

Address or P.O. Box:

Apartment Number:

City:

Province:

Postal Code:

R2 Source of Marihuana

You are required to choose one of the following:

o I plan to purchase dried marihuana from Health Canada and request that my approval to receive dried marihuana

be renewed.

IMPORTANT: If you want to purchase dried marihuana but do not currently have approval to receive the Health

Canada product, you are required to complete FORM E1: Application to Obtain Dried Marihuana.

o I plan to produce my own marihuana and request that my existing Personal-Use Production Licence be renewed.

IMPORTANT: If you want to produce your own marihuana and do not currently hold a valid Personal-Use

Production Licence, you are required to complete FORM C: Application for Licence to Produce Marihuana

by Applicant.

o I plan to have a designated person grow marihuana for me.

IMPORTANT: You are required to complete FORM D: Application for Licence to Produce Marihuana by a

Designated Person even if renewing an application.

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Form R Application For Renewal Of Authorization To Possess Medical Marihuana The Medical Marijuana Mission Page 2

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