Importer’s Statement of Compliance for Shelf-Stable, Thermally Processed

Pet Food, Chews, and Treats from Canada to the United States

PRODUCT DESCRIPTION:

Pet chews or treats Pet food

NAME OF IMPORTER INCLUDING COMPANY Address

City State Zip Code

DECLARATION:

I undersigned ________________________________________, do hereby declare the shipment contains products of

Canadian or U.S. origin:

1- described on the Customs Invoice or Commercial Invoice Number(s):

2- certified by the accompanying original(s) or copy(ies) of CFIA Veterinary Certificate(s):

and certify that the information provided on this form is complete, correct and accurately describes the product contained in the

shipment.

Signature___________________________________ Date_______________________________________

For the Broker or Importer

Transaction Number Exporter Reference Number (optional)

Customs Entry Number (optional) Total Gross Weight

Container(s) and Seal number(s) Lot or Batch number(s)

Certificate Number(s) [ORIGINAL Certificate] Certificate Number(s) [Copy of an Original Certificate*]

*Please note that the ORIGINAL certificate must be utilized for an importation prior to copies of that certificate being presented. Importers should also be aware that they may be required to provide shipment information (entry #, port of entry, date of entry, etc) of the shipment where the original certificate was presented.Shipments from Canadian processing facilities that obtain a "VS Special Authorization letter" to utilize copies of certificates for all shipments areexempt from having to present the original certificate prior to utilizing copies of a certificate.