Becoming A Client - Form D Instructions

Form D: Application for License to Produce Marihuana by a Designated Person

D1: Application for license to Produce Marihuana by a Designated Person

Indicate whether you are Mrs., Miss, Ms, or Mr. by checking the correct square.

Print your full name:  first, middle and last

Print your correct birth date:  day, month, and year.  (example 07 January 1945)

Printyour complete address starting with your house number, street (and state street, avenue) if you have an apartment number, fill it in, if not leave it blank. Next put your city, province and postal code.

Put a line through the next two lines (lot number and concession number)

Fill out your telephone and fax numbers, as well as your email address (if you have them)

If you have or have ever had an MMAR card previously, then fill in your MMAR card number.  If not, leave the box blank.

D2 , D3, D4, D5, D6, & D7

These sections can be left blank or crossed out.

D8: Part A-Applicant`s Declaration And Signature

You will need to sign you name in full, printtoday’s date a print your full name

D8: Part B - Designated Person's Declaration and Signature

These sections can be left blank or crossed out.