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: