Word Version This form pertains to injury inquiries under section 42 and reviews under sections 76.01 and 76.03 of the Special Import Measures Act. Instructions Complete a form for each reply. File each completed form no later than the date set out in the schedule. Use the Canadian International Trade Tribunal’s Secure E-filing Service to file your form(s). The information is fully encrypted. Include all attachments in electronic format. If you want to designate some of the information as confidential, submit two versions to the Tribunal: A confidential version containing all the confidential information and marked “PROTECTED” on each page that contains confidential information. In addition, all confidential information should be highlighted by using shading, boldface characters or square brackets; and A public version of the same document with the confidential information fully deleted (not just masked or hidden) if you’re filing electronically. Instead of filing a public version, you can file a public summary of the confidential information. The Tribunal may request that you file one if the public version isn’t satisfactory. In either case, the public version or the public summary must give the party opposite and the Tribunal sufficient information to understand the nature of the confidential information. Don’t include this page when filing your form(s). Exclusion request information Requester (company name) Product exclusion request number Name of tribunal case Tribunal case number Company information Name Contact Address City and province Postal code Telephone Fax Email Representative or counsel information Firm Representative or counsel Address City and province Postal code Telephone Fax Email Reply Reply Enclosures List all enclosures provided in support of your reply. Public enclosures Confidential enclosures Name of authorized official Title of authorized official Date If you provided confidential information, you must designate it as such and provide a public summary that contains sufficient detail to convey a reasonable understanding of the substance of the information. I understand that checking this box constitutes my legally binding signature. This box must be checked for the form to be considered complete. Print