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Application for Copyright Clearance of Government of Canada Works

From Financial Consumer Agency of Canada

* indicates mandatory field.

1. APPLICANT INFORMATION

Complete Name

Organization Name

Type of Organization

Postal Address

City/Town

Province/State

Postal/Zip Code

Country

Telephone Number

Facsimile

E-Mail Address

Web Site Address

If permission is granted, person/organization in whose name permission is to be issued

Individual named above

Organization named above

Other (specified below)

4. ADDITIONAL INFORMATION

Applicant Reference Number (If you wish to assign one)

I would appreciate a response by

Have you previously received approval to use the same material(s)?

Yes

If yes, previous Crown Copyright File No

Reproduction	Adaptation
Revision	Translation (specify languages of your work below)

Commercial	Non-Commercial
Cost recovery	Promotional

Database	Figure
Footage	Illustration
Map	Photo
Table	Text
Whole Work	Other (Specify additional information below)