ANNEX J

Application to Return Canadian Products Exported to the United States of America

Number:

In the event a product exported to the United States of America is refused by the Food Safety and Inspection Service, the applicant must present a written request to the Import Service Centre authorizing the return of the product to Canada. The request must be presented to the regional Import Service Centre where the product will arrive in Canada.

The Application to Return Canadian Products Exported to the United States of America has three parts to fill out and has the following fields to fill out

Part 1. Applicant

1. Name of Applicant
2. We, the exporter listed on the Canadian Food Inspection Agency form 4546, hereby request permission to bring back into Canada the following product:
   • Product description
   • Weight
   • Manufacturing establishment (number and name)
   • Date and place of refusal
   • Reasons for return
3. We are attaching applicable official documents Canadian Food Inspection Agency form 4546, Food Safety and Inspection Service form 9840-3 or 9135-3 with Food Safety and Inspection Service statement¹
4. Product to be returned and inspected:
   • Establishment number and name
   • Address
   • Transport company
   • Projected date and time of arrival at port of landing
5. Firm's representative:
   • Name
   • Signature
   • Date
   • Telephone number
   • Fax number

Part 2. Import Service Centre - Area Program Network Director

1. Permission granted by:
2. Title and date:

Part 3. Inspection port of landing

1. Permission given to proceed to inspection destination (answer yes or no)
2. Other conditions

¹Delete the mention(s) that are not applicable