Application for Copyright Clearance of Government of Canada Works

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Privacy Statement

The personal information collected is to be used to respond to your request for copyright clearance on Government of Canada works. Provision of the information requested on this form is voluntary. An incomplete form may result in the rejection of your request or a time delay in processing your request. All personal information created, held or collected by the Department of Justice is protected under the federal Privacy Act. At any point of collection you will be asked for consent to collect your information, and you will be informed of the purpose for which it is being collected and how to exercise your right of access to that information.

For assistance in completing this form, please contact us at the coordinates shown at the end of this form. Please note that this form applies to the Department of Justice Canada works only, and that all fields marked by an asterisk (*) must be completed.

1. Applicant Information

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

2. Information on the Applicant's Work

Purpose (required)

N.B. If the Department of Justice Canada material has been adapted or revised, copies of your adapted/revised work and the Department of Justice Canada material must be included with your request.

Format(s) in which your work will be produced (required)
End Use (required)

Or

3. Information on the Government of Canada Work

Format of Source Material (required)

Or

Precise description of material to be used (required)

4. Additional Information

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

Please address all correspondence to:

Department of Justice Canada
Communications Branch
Copyright administrator
284 Wellington Street
Ottawa, Ontario  K1A 0H8
Facsimile: (613) 948-2983
Email: webadmin@justice.gc.ca

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