Appendix 4: Application Form to Order Export Certification Labels and the Interfacility Stamp

This form has three parts. The first part provides information on the person placing the order, the establishment registration number, Number labels / Stamps required, the last serial number used and a billing address. It also needs to be signed and dated.

The second and third parts of the form are for government use only. The second part should be filled up by a Canadian Food Inspection Agency Inspector. It shows the new serial numbers, name and signature of the CFIA inspector and is also dated.

The third part is reserved to the regional CFIA Office and will provide the printer / stamp maker's name, address and the delivery address for the Expot Certification Labels. This part is also signed and dated by the authorized person.