Application Form to Order Movement Certification Labels

The following information is required on this form:

NOTE: This form is for use in Canada - for Official Use Only

Part one: Person Ordering

Name

Grower Identification Number

Number Required

Signature

Date

Billing Address

Part two: Authorized by Canadian Food Inspection Agency Inspector

Serial Numbers

Name

Signature

Date

Part three: Regional Office

Printer (Name and Address)

Please send the Movement Certification Labels to:

Signature of Authorized Person

Date

Original to Regional Office

Copy one to Canadian Food Inspection Agency Inspector