MDPPACPB Regulations

Page 93 of 127
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SECTION D: DURATION AND CONDITIONS 
13. Proposed duration of exemption (in months/years): ______________________ 
14. Any proposed conditions or limitations (if any): _________________________ 
 
SECTION E: DECLARATION 
I/We declare that the information provided is complete, accurate, and not 
misleading. 
Signature: _________________________ 
Name: ____________________________ 
Date: ____________________________ 
 
 
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SCHEDULE 3 
Regulation 75(2) 
 
Competition Complaint Form (To be submitted Pursuant to Regulation 75(2) 
under Part XIV of these Regulations) 
 
Complaint Reference Number: ___________________________ 
Date of Submission: ___________________________ 
Section A: Complainant Information 
1. Name of Complainant: __________________________________________ 
2. Organization (if applicable): ____________________________________ 
3. Address: _____________________________________________________ 
4. Phone Number: _______________________________________________ 
5. Email Address: ________________________________________________ 
Section B: Respondent Information 
6. Name of Alleged Offending Party: _________________________________