NHP Application Withdrawal Request Form

Privacy notice

The personal information you provide to Health Canada will be used by the Natural and Non-prescription Health Products Directorate (NNHPD) under the Natural Health Products Regulations and handled in accordance with the Privacy Act.

Why are we collecting your personal information?  We are collecting your personal information to ensure that only designated parties are able to provide information on behalf of a company.

What are your rights?  You have the right to access and request a correction and/or notation to your personal information. You also have a right to complain to the Privacy Commissioner of Canada if you feel your personal information has been handled improperly. For more information about how we handle your personal information, please contact the NNHPD.

For more information: The collection of your personal information is described in Info Source at infosource.gc.ca. Refer to the Public Communications (PSU 914) personal information bank.

Enter the date this form is being completed

Year

Month

Day

Company code

Company name

Full name of Authorized Signing Official (Senior Official or an authorized designated party)

Title

Email address

For example: name@example.com

Preferred language for communication

English

French

Withdrawal request to:

Withdraw specific submissions for which I have a submission number

Withdraw specific applications for which I do not have a submission number but have the tracking number

Please note that separate forms are required depending on the status of the application/submission: one form must be used for the withdrawal of applications (i.e., those with a tracking number), and a separate form must be used for the withdrawal of submissions (i.e., those with a submission number).

Date modified: 2025-09-08