Appendix G - C-PIQ Export Document

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Specimen - Export document for Canadian Partners in Quality establishments Fresh fruit and vegetables

Description for Export document for Canadian Partners in Quality establishments Fresh fruit and vegetables

Client Account No.

I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.

C-0023007

The establishment described above is operating under a Canadian Food Inspection Agency (CFIA) recognized quality assurance program aimed at verifying that the products meet the Fresh Fruit and Vegetable Regulations and the U.S. Import Requirements of 7 U.S.C. 608e-1. The establishment is monitored and audited by the CFIA for compliance with the requirements of this program, referred to as Canadian Partners in Quality (C-PIQ).

Information may be accessible or protected as required under the provisions of the Access to Information Act.

Commodity Code

C-PIQ Registration No.

C-PIQ Establishment

Address

Shipper

Same as Establishment

C-PIQ Establishment

PRODUCT DESCRIPTION

Marks on packages

No.

Product/Type/Variety

Lot Identification

Number and Type of Packages

Declared Grade

Remarks

The product described above originates in the province of

Net weight (kg)

U.S. Customs Entry No.

Inspector Name (print)

Signature

I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.

I hereby warrant and certify that I have the authority to sign this Export Document on behalf of the C-PIQ establishment identified above.

I hereby do warrant and certify that all the information contained on and in this Export Document is fully true and accurate and that the product described above was prepared in and shipped from a facility operating under the C-PIQ program.

I understand and acknowledge that if any information set out herein is found to be false, misleading or deceptive, this may result in legal action by the CFIA.

Name of Establishment signatory

Signature

Date

Completing the export document

For CFIA only: The inspector must access the Export Document using one of the following methods:

  • Go to Merlin, Quick Links, Forms, Forms Management: Search for a Form, Enter Form No.: 5314, Click on Search, Open Form
  • Start, All Programs, Desktop eForms, Services, Distribution Center, English, Operational, Find "EXPORT_DOCUMENT_C-PIQ_5314.itp

Print Export Document on: 8.5" x 14" legal paper with pre-printed CFIA Corporate Signature and Canada Wordmark.

To be completed by the CFIA:

  • C-PIQ Establishment (full name);
  • C-PIQ Registration Number;
  • Commodity Code;
  • Name and Signature of the CFIA Inspector.

Note: Informed Filler will assign a unique official Export Document number for each document.

To be completed the C-PIQ Registered Establishment:

  • C-PIQ Establishment address;
  • Shipper (full name and address). Same as establishment when Shipper and Establishment are same;
  • Consignee (full name and address – minimum requirement of city, state/province, country).

Product Description

  • Marks on Packages (full description including which marks are associated with a particular lot);
  • Product / Type / Variety (e.g. Potatoes / Long Type; Potatoes / Round Type; Potatoes / Round Type / Yellow Fleshed)
    (Note: variety is not required for potatoes);
  • Number and Type of Packages (quantity and description of package; e.g. 900 master container 10 x 5 lb poly bags; or 500 x 50 lb cartons);
  • Declared Grade (grade as declared on the packaging, or on an invoice or manifest in the case of bulk shipments);
  • Lot ID (the unique C-PIQ lot identification number assigned to package or pallet for traceability, and the date code);
  • Remarks (to be used for information not specified in any other box; e.g. Truck number; and additional space for Lot ID information too large for Lot ID box);
  • Product origin declaration (a Plant Protection requirement; APHIS and US Customs require a statement of origin for each shipment);
  • Net Weight (kg) (declaration of net weight of the shipment in kilograms (conversion 1 kg = 2.2045 lbs));
  • Client Account Number
  • US Customs Entry No. (this is a US requirement);
  • Name of Establishment Signatory, Signature and Date (Declaration of Establishment Signatory – Name and Signature of the C-PIQ Registered Establishment personnel authorized to request, complete and issue C-PIQ Export Documents, and the date on which the document was issued).
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