This form must be filled in for the export of untreated wood product to the European Union. There are 17 fields to fill in plus date and signature.
EXPORTER (name and address) [1]
CONSIGNEE (name and address) [2]
IMPORT ENTRY REFERENCE [3]
BUYER CONTRACT NO. [4]
CERTIFICATE NO. [5]
DATE [6]
LOT NO. [7]
MILL [8]
MILL NO. [9]
SHIP NAME [10]
POINT OF LOADING [11]
PORT OF EXIT [12]
PORT OF DESTINATION [13]
COUNTRY OF ORIGIN [14] CANADA
COUNTRY OF DESTINATION [15]
DESCRIPTION OF CONSIGNMENT [16]
This document has been issued under the program officially approved by Agriculture Canada, Plant Protection Division and the products covered by this document are subject to occasional pre-shipment inspection by that agency, without financial liability to it of its officers
This lumber has been examined by a mill inspector, shipper, or other authorized person and found to have been stripped of its bark and to be free of grub holes to conform to the best of their knowledge and belief, with the import requirements of the receiving country.
AUTHORIZED PERSON RESPONSIBLE FOR CERTIFICATION [17]
Print Name
Signature
Date