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Revenue Canada Revenu Canada CANADA CUSTOMS INVOICE
Customs and Excise Douanes et Accise 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'axpedition directe vers le Canada

3. Other References (include Purchaser's Order No.)
Autres references (Inclure ie no de commande de I'acheteur)

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

5. Purchaser's Name and Address (If other than Consignee)
Nom et adresse de I'acheteur (S'il differe du destinataire)

6. Country of Transhipment / Pays de transbordement

7. Country of Origin of Goods
Pays d'origine des machandises

IF SHIPMENT INCLUDES GOODS OF DIFFERENT ORIGINS
ENTER ORIGNS AGAINST ITEMS IN 12.
SL L'EXPEDITION COMPREND DES
MARCHANDISES D'ORIGINES DIFFERENTES.
PRECISER LEUR PROVENANCE EN 12
8. Transportation : Give Mode and Place of Direct Shipment to Canada
Transport : Preciser mode et point d'expedition directe vers le canada

9. Conditions of Sale and Terms of Payment
(i.e.Sale, Consignment Shipment, Leased Goods, etc.)
Conditions de vente et modalites 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, i.e. Grade, Quality)
Designation des articles (Nature des colis, marques et numeros, description generale et
caracteristiques, p. ex. classe, qualite)

13. Quantity
(Stato Unit)
Quantite
(Preciser I'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 les renseignements des zones 1a 17 figurent sur la facture commerciale, cocher cette boite

Commercial invoice No. / NO de la facture commerciale
□

16. Total Weight / Poids Total
17. Invoice Total
Total de la facture

Net

Gross / Brut

19. Exporter's Name and Address (if other than Vendor)
Nom et adresse de I'exportateur (S'il differe du vendeur)

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

21. Departmental Ruling (If applicable) / Decision du Ministere (S'ily a lieu)

22. If fields 23 to 25 are not applicable. check this box
Si les zones 23 a 25 sont sans objet, cocher cette boite

□
23. If included in field 17 indicate amount :
Si compris dans le total a la zone 17. preciser.

(i) Transportation charges, expenses and insurance from the place
of direct shipment to Canada
Les frais de transport, depenses et assurances a partir du point
d'expedition directe vers le Canada
$
(ii) Costs for construction, erection and assembly incurred after
importation into Canada
Les couts de construction. d'erection et d'assemblage apres
importation au Canada
$
(iii) Export packing
Le cout de I'emballage d'exportation
$
24. If not included in field 17 indicate amount :
Si non compris dans le total a la zone 17, preciser :
(i) Transportation charges, expenses and insurance to the place of direct shipment to Canada Les frais de transport, depenses et assurances jusqu'au point d'expedition directe vers le Canada
$

(ii) Amounts for commissions other than buying commissions Les commissions autres que cellas versees pour I'achat
$

(iii) Export packing
Le cout de I'emballage d'exportation
$
25. Check (If applicable) :
Cocher (S'ily a lieu) :

(i) Royalty payments or subsequent proceeds are paid or payable by the purchaser Des redevances ou produits ont ete ou seront verses par I'acheteur
□
(ii) The purchaser has supplied goods or services for use in the
production of these goods
L'acheteur a foumi des marchandises ou des services pour la
production des marchandises
□

DEPARTMENT OF NATIONAL REVENUE·CUSTOMS AND EXCILE MINSTERE DU RENENU NATIONAL·DOUANES ET ACCISE


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