Appendix H - Request for export documents for C-PIQ Establishments

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To be completed by the Requestor

I (authorized requestor) space, of (C-PIQ establishment name and number) space 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: space
  • Signature of Authorized Requestor: space
  • Date of Request: space

To be completed by the CFIA

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

  • Export Document Numbers: space
  • Signature of space
  • Date of Issuance: space

To be completed by the establishment representative

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

Name of representative: space

Signature of representative: space

Date of receipt of documents: space

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