Ontario Retail Sales Tax Purchase Exemption Certificate

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ONTARIO RETAIL SALES TAX
PURCHASE EXEMPTION CERTIFICATE
Blanket
Business Name:
Business Address:
Vendor Permit Number (if applicable):
Nature of Business:
Reason for Claiming Exemption:
I claim exemption from Ontario retail sales tax under the provisions of the Retail Sales Tax Act
on the following goods or taxable services, contracts of insurance or benefits plan:
Signature of Authorized Person
Date
(Print) Name of Authorized Person
The person buying the goods or taxable service, or entering into a contract of insurance or benefits plan for
which an exemption is claimed must complete this certificate and give it to the supplier.
The supplier is to keep this form as stated in the regulations. This certificate is valid for four years if,
(a) the box beside the word “blanket” at the top of the form is checked; and
(b) the purchase order refers to this Purchase Exemption Certificate.
Every person who makes a false statement on a Purchase Exemption Certificate or misuses the certificate is
liable, if convicted, to a fine of not less than $1,000 and an amount of not more than double the amount of the
tax that should have been paid, or that was evaded, or to imprisonment for a term of not more than two years,
or to both.

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