Client Account No.
I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.
C-0023007
The establishment described above is operating under a Canadian Food Inspection Agency (CFIA) recognized quality assurance program aimed at verifying that the products meet the Fresh Fruit and Vegetable Regulations and the U.S. Import Requirements of 7 U.S.C. 608e-1. The establishment is monitored and audited by the CFIA for compliance with the requirements of this program, referred to as Canadian Partners in Quality (C-PIQ).
Information may be accessible or protected as required under the provisions of the Access to Information Act.
Commodity Code
C-PIQ Registration No.
C-PIQ Establishment
Address
Shipper
Same as Establishment
C-PIQ Establishment
PRODUCT DESCRIPTION
Marks on packages
No.
Product/Type/Variety
Lot Identification
Number and Type of Packages
Declared Grade
Remarks
The product described above originates in the province of
Net weight (kg)
U.S. Customs Entry No.
Inspector Name (print)
Signature
I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.
I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.
I hereby do warrant and certify that all the information contained on and in this Export Document is fully true and accurate and that the product described above was prepared in and shipped from a facility operating under the C-PIQ program.
I understand and acknowledge that if any information set out herein is found to be false, misleading or deceptive, this may result in legal action by the CFIA.
Name of Establishment signatory
Signature
Date