A-372 Relinquishment of Cannabis Retail Licence Form

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Relinquishment of Cannabis Retail Licence

Date of Relinquishment

Cannabis Retailer Licence Holder Name

Phone

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Licence Number

Reason for Relinquishment

I am relinquishing my cannabis retail licence for the following reasons:

Disposal of Cannabis Held by Cannabis Retail Licence Holder:
As required under section 28(b)(iii) of the Cannabis Regulations, I have disposed of the cannabis in my possession in the following manner:

Date/Time of Disposition

I have destroyed the cannabis as per section 21 of the Cannabis Regulations and have attached a copy of the Cannabis Destruction Report;

I have sold/given the cannabis to another Nunavut Cannabis Retailer, Name of Retailer in receipt of cannabis:

Name of Retailer in receipt of cannabis;

I have forfeited the cannabis to the Government of Nunavut; or

I have removed the cannabis from Nunavut,

Name of Registered Supplier in receipt of cannabis

Steps

Current Relinquishment of Cannabis Retail Licence
Description of Cannabis Disposed of:
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