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)
• Print your 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

• MedMe will complete these sections for you

D8: Part A-Applicant`s Declaration And Signature

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

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

• MedMe will complete this section for you