Annex H - Request for export documents for C-PIQ establishments

To be completed by the Requestor

I (authorized requestor) , of (C-PIQ establishment name and number) request
EXPORT DOCUMENTS FOR C-PIQ ESTABLISHMENTS FRESH FRUIT AND VEGETABLES from the Canadian Food Inspection Agency, for use exclusively by our C-PIQ registered establishment as per the C-PIQ program requirements and our Company CFIA Manual.

Quantity of Export Documents requested:
Signature of Authorized Requestor:
Date of Request:

To be completed by the CFIA

I (CFIA personnel) , have provided to (authorized establishment requestor) the quantity of EXPORT DOCUMENTS FOR C-PIQ ESTABLISHMENTS.

Export Document Numbers:
Signature of CFIA personnel:
Date of Issuance:

To be completed by the establishment representative

I accept these EXPORT DOCUMENTS FOR C-PIQ ESTABLISHMENTS, on behalf of (C-PIQ establishment name) .

Name of representative:

Signature of representative:

Date of receipt of documents: