Appendix C: Application for Consideration as a C-PIQ Registered Establishment

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Specimen - Application for consideration under the program (C-PIQ)
Description for Application for Consideration as a C-PIQ Registered Establishment
  1. Type of application:
    1. New
      1. All new applicants to the C-PIQ Program.
      2. All applicants for whom a C-PIQ registration has been cancelled who are now seeking to once again apply to become registered.
    2. Revision
      1. All applicants providing an up-date of a previously submitted application, due to changes in the officers or other application information provided to the CFIA.
  2. Preferred language of correspondence: English or French
  3. Current RPW # and/or C-PIQ # (if applicable)
    A three-digit number. Registered Produce Warehouse registration is separate from the C-PIQ registration (even if the number appears to be the same).
  4. Expiry date of RPW and/or C-PIQ registration
    The date of expiration of the Registered Produce Warehouse or Canadian Partners in Quality registration as stated on the Certificate of Registration
  5. Legal name of applicant as registered
    The full legal name under which the establishment will be or is registered as a C-PIQ establishment. Abbreviations may only be used where the abbreviation forms part of the official and full establishment name.
  6. Also doing business as (if applicable)
    Where the establishment is also known by, or does business under another name, the other full name must be provided.
  7. Street address or location of establishment
    The full and complete civic address of the establishment, including postal code.
  8. Mailing address (if different from location of establishment)
    The full and complete mailing address of the establishment, including postal code, if the mailing address is different from the physical address of the establishment identified in previous box.
  9. Telephone number; facsimile number; and e-mail address (where applicable) are required. Include area code.
  10. Legal status of business
    Business may or may not be officially recognized as a legal entity by the province in which it operates. The status must be declared on the application form
    1. Corporation or limited company – if so registered, a copy of the federal or provincial documents of incorporation or proof of business must be attached;
    2. Partnership – if provincially or federally recognized, documents or incorporation or proof of business must be provided. If not, declaration of partnership is required, signed by partners.
    3. Individual – if provincially or federally recognized, documents or incorporation or proof of business must be provided. If not, declaration of ownership is required;
    4. Co-operative – if provincially or federally recognized, documents or incorporation or proof of business must be provided. If not, declaration of co-operative members is required.
  11. Name of owner of establishment
    Indicate the full name of establishment owner(s). Use a separate sheet if necessary.
  12. Name of operator of establishment
    Indicate the full name of establishment operator.
  13. Answer Yes or No to the following (where a Yes answer is provided, a brief explanation is required in the adjacent box)
    1. Have you previously applied for registration of an establishment?
      Answer Yes where applicant:
      1. applied for, but was refused registration, or
      2. was granted a previous C-PIQ registration or RPW registration (whether current, suspended or cancelled).
    2. Have you ever had a certificate of registration suspended or cancelled?
      1. Answer Yes where a previously issued RPW or C-PIQ registration number was suspended or cancelled.
      2. Provide details including dates and previous registration numbers.
    3. Have you ever had a judgement rendered against you or your company with respect to any violation of the Canada Agricultural Products Act or the Fresh Fruit and Vegetable Regulations?
      1. If Yes, provide details for the incident or violation, including dates.
  14. Name and position of person(s) responsible for the supervision of your Quality Assurance system and preparation of product
    1. Name and position must also be clearly stated in Company Manual;
    2. Quality Assurance person is primary contact for the CFIA when discussing packaging, labelling and grade non-compliance issues;
    3. Indicate on the application form the name of the person responsible for the supervision of preparation of product, if different from that of the person responsible for the supervision of your Quality Assurance system.
  15. List kind of produce prepared in your establishment
    List all produce prepared in your establishment.
  16. Company Quality Assurance Manual attached? YES / NO If no, expected date of submission.

    A Company QA Manual is required to be submitted to complete registration. However, the Manual may be submitted with the application or at a later date. If submitted at later date, please provide an anticipated date of submission.

  17. Application fee of $500 to be attached. Fee to be provided by cheque, money order, bank draft or credit card (VISA or MasterCard). Payable to Receiver General for Canada. Fee is non-refundable.
  18. Method of payment
    Check off method of payment used. If paid by VISA or MasterCard, indicate credit card number and expiry date. Name of card holder to be printed and card holder to sign and date form in appropriate area.
  19. Signature, title or official capacity, and date of signature of the person making application for registration on behalf of the establishment. This person must be a person of authority within the management of the establishment.

For Agency use only (to be completed by the appropriate CFIA staff in District, Regional, Area or Headquarters office)

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