CHS intellectual property application form

* denotes a mandatory field

These products are being requested for:

Non-navigational use

Navigational use

For navigation, please Purchase charts for navigational use.

Previous Licences

Please enter any references numbers for existing or expired licences you have entered into with the CHS (e.g., yyyy-mmdd-1260-X)

Applicant information

First name

Last name

Email address

If applying as a business, training organization, government employee, or for university science research, enter the business or organization’s information below.

Address

City

Province/state

Country

Postal code

Telephone

Web site

Your title/position

Full legal name of company/organization or government department and branch

Structure of business

Type of incorporation

Other

*Federal Crown agent?

Yes

Mailing address (if different)

If a business: incorporated under the laws of

Province

Country

Date incorporated (YYYY-MM-DD)

Additional contact

If there is an additional contact, please add the name here. If you checked “I am a student”, you must provide the full name and business address of a permanent faculty member, who will be required to sign the licence agreement.

Name

Title/position

Company/organization

Phone

Address

City, province/state, country

Postal code

CHS intellectual property requested

Please specify the CHS IP you wish to access/copy/modify/reproduce. To assist you in itemizing the products you require, please refer to the on-line catalogue or product listings. Please be as precise as possible to help us process your request as quickly as possible.

Please state clearly the nature of your business and intended use of the CHS IP. Describe any intended creation of products to be sold commercially, products which will not be sold, and/or published papers, web sites, research activities or other forms of distribution. Please include product edition numbers, if applicable.

Intended use (50 characters minimum)

If you are creating a product to be sold commercially, what is your estimated price for each of your product(s) derived from or including CHS IP? If you need more space than available on this form please follow up with CHSInfo.

Name/type of product

Estimated quantity Iintended for distribution

Estimated wholesale price

Estimated retail price

Please indicate your target sales or distribution forecast for the term of the licence.

For Value Added Reseller Products, what percentage of your product will be comprised of CHS intellectual property? Please describe the method(s) used to establish this proportion. For more information, please visit Licensing Options (charts.gc.ca).

Sub-contractors or other organizations will need access to the data

Yes

If a sub-contractor or another organization will need access to the data or if an agent will provide services related to the licence, please identify

Full legal name of company/organization or Government department and branch

Business address

City, province/state, country

Postal code

Telephone

Email address

Web site

Responsibilities of/services to be provided by sub-contractor/agent

Please include any additional supporting information that you feel will help us to better assess your application.

Date CHS IP required (YYYY-MM-DD)

Availability by date required cannot be guaranteed

Declaration

Declaration I declare that I have the authority to submit this declaration on behalf of the applicant, and I declare that the information that I have supplied is true and accurate to the best of my knowledge, and that any revisions to the information provided above will be immediately provided in writing to the CHS licensing representative.

Printed name

Date

A confirmation page will appear if the application has been successfully submitted. If you do not see a confirmation page, please contact chsinfo@dfo-mpo.gc.ca.

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CHS intellectual property application form

Previous Licences

Applicant information

If a business: incorporated under the laws of

Additional contact

CHS intellectual property requested

Declaration