Canadian Food Inspection Agency Certificate Of Origin printable pdf download

Certificate of Origin

To: The Canadian Food Inspection Agency

A Certificate of Origin is required in order to export material to Canada that is regulated for light brown apple moth

(LBAM)* and that was produced in a county of California that Canada does not regulate for LBAM. Appendix 2 of

D-07-03 lists the California counties that are regulated by Canada for LBAM.

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The Certificate of Origin must be filled out completely. Any shipment accompanied by a Certificate of Origin

that is not completed correctly may be refused entry into Canada.

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If a shipment includes commodities from several counties, each county must be listed on a separate certificate.

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A single Certificate of Origin must be completed for each different commodity within a shipment.

* Carrots with tops removed, radishes with tops removed as well as highly processed vegetables and highly processed

fruit (chopped, sliced, peeled, etc.) are exempt from the requirements for light brown apple moth. Refer to Import

Directive D-07-03.

The products described below are produced in the California county of:

______________________________________ in an area where light brown apple moth (Epiphyas

postvittana), is known not to occur.

Exporter’s Name: __________________________________________________________

Exporter’s Address:

Street Address: _____________________________________________________________

City/ Town:

____________________________________________________________

State:

______________________

Zip Code: ________

Product Description:

Scientific (Botanical) Name: ___________________________________________________

Common Name: ____________________________________________________________

Quantity (weight, # of lots, etc.)**: _______________________________________________

Document reference (bill of landing #, airway bill #, invoice # , Canada Customs Invoice #, etc.)**:

__________________________________________________________________________

** Information provided must be sufficient to show that the commodity referred to on this certificate of origin

corresponds directly to that shown on import documents.

By signing this Certificate of Origin, the above named exporter certifies that the material described above

was produced in a California county in which light brown apple moth is known not to occur.

_____________________________

________________________________

Name of exporter (printed)

Signature of exporter

________________

Date (yyyy/mm/dd)

Canadian Food Inspection Agency Certificate Of Origin