Revenue Canada

Customs and Excise

Revenue Canada

Douanes et Accise

CANADA CUSTOMS INVOICE

FACTURE DES DOUANES CANADIENNES

Page

of

de

1. Vendor (Name and Address) Vendeur (Nom et adresse)

2.Date of Direct Shipment to Canada/Date d' expedition directe vers ie Canade

3.Other References (include Purchaserys Order No.)

Autres reterences(inclure ie n de commande de Í acheteur)

4. Consignee (Name and Address) Destinataire (Nom et adresse)

5. Purchaser's Name and Address(if other than Consignee)

Nom et adresse de Í acheteur(S'll differe du destinataire)

6. Country of Transhipment/Pays de transbordement

7. Country of Origin of Goods

pays d' origine des marchandises

IF SHIPMENT INCLUDES GOODS OF DIFFERENT ORIGINS ENTER ORIGINS AGAINST ITEMA IN12

SIL' EXPEDON COMPREND DES MARCHANDISES D'

ORIGINES

DIFFERENTES PRECISER LEUR PROVENANCE EN12

CHINA

8. Transportation Give Mode and Place of Direct Shipment to Canada

Transport Preciser mode et point d' expedition directe vercte vers ie

canada

9. Condirtions of Sale and Terms of Payment

(i.e Saie. Consignment Shipment, Leased Goods, etd.)

Conditions de vente et modaitites de paiement

(P.ex vente, expedition en consignation, location, de marchandises, etc)

10.Currency of Settlement/Devises du paiement

11.No of

Pkgs

Nore de

colis

12.Specification of Commodities (Kind of Packages,Marks,and Numbers,General

Description and Characteristics, ie Grade, Quality)

Designation des articles (Nature des colis, marques et numeros, description ger erale

et caracteristiques,, P ex classe, qualite)

13. Quantity

(State Unit)

Quantite

(Preciser Í unite)

Selling Price/Prix de vente

14.Unit Price

Prix unitaire

15. Total

18. if any Of fields 1 to 17 are included on an attached commercial invoice, check this box

si tout renseignement relatlvement aux zones 1 e 17 ligure sur une ou des tactures

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16. Total Weight/Poids Total

17. Invoice Total

Total de la facture

Net

Gross/Brut

commerciaies ci-attachees cocher cette case

commercial invoice No. 1 N de la factre commerciaie

____________________________

19.Exporter's Name and Address(if other than Vendor)

Nom et adresse de Í exportateur(s'll differe du vendeur)

20.Originator (Name and Address)/Expediteur d' origine(Nom et adresse)

21.Departmental Rulikg(if applicable)/Decision du Ministere(S' lly a lieu)

22.If fields 23 to 25 are not applicable, check this box

Si ies zones 23 e 25 sont sans objet, cocher cette case

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23.if included in field 7 indicate amount

Si compris dans ie total a ia zone 17, preciser

(Ⅰ)Transportation charges, expenese and insurance

from the place of direct shipment to Canada

Les frais de transport, depenses et assurances

a partir du point of expedition directe vers is

Canada.

24.If not included in field 17 indicate amount

Si non compris dans le total a ie zone 17, Dreciser

(Ⅰ)Transportation charges, expense and insurance

to the place of direct shipment to Canada

Les frais de transport, depenses et assurances

Iusqu' au point d' of expedition directd vers ie Canada

25.Check (if applicable)

Cochet (s'lly a liso)

(Ⅱ)Royalty payments or subsequent proceede are

paid or payable by the purchaser

Des redevances ou prodults ont ete ou seront

Verses par Í acheteur

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(Ⅱ)Amounts for commissions other than buying

commissions

Les commissions autres que celles versees

Pour Í achat

(Ⅱ)Costs for const: action, erection and assembly

incurred atter importation into Canada

Les couts de construction, d' erection et

d' assemblage,, pres imporaation au.Canada

(Ⅱ)The purchaser has supplied goods or services

for use in the production of these goods

L'acheteur a fouml des merchandises ou des

Services pour ia production des merchandises

(Ⅲ)Export packing

Le cout de Í emballage d' exportation

(Ⅲ)Export packing

Le cout de Í emballage d' exportation

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