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WITHDRAWAL BUYBACK FORM Use this form “ONLY when you receive notice from BCC that a specific product is being “Withdrawn from the market. Please refer to the retailer information sheet you have

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4. Follow the instructions for each section of the form. Provide accurate and complete information as requested.
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8. Sign and date the form as required.
9. Submit the form through the designated method mentioned in the instructions. This can be electronically or physically, depending on the form and its requirements.
10. Keep a copy of the filled-out form and any supporting documents for your records.

Who needs to use this form only?

1. Individuals who are required to provide specific information or documentation for a particular purpose, such as applying for a license or certification.
2. Anyone who is seeking a specific service or benefit that requires the use of this form.
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What is use this form only?

This form is used for specific purposes.

Who is required to file use this form only?

Only individuals who meet certain criteria must file this form.

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The form can be filled out online or by mail following the instructions provided.

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The purpose of this form is to gather specific information from eligible individuals.

What information must be reported on use this form only?

The form requires information related to the specific criteria that needs to be reported.