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Montreal, Quebec, Canada H3A 2T5 Declaration for Import of Biological Products Complete this form and fax it back to: (514) 398-1885 Zip/Postal Code: 

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McGill University

845 Sherbrooke Street West

Montreal, Quebec, Canada

H3A 2T5

Declaration for Import of Biological Products

Complete this form and fax it back to: (514) 398-1885

Date: ________________________

To: Canadian Food Inspection Agency - Government of Canada Please find below the information needed to facilitate passage through customs. Name and Address of Exporter: Name and Address of Importer: Name: ________________________________ Name: __________________________________ ________________________________ __________________________________ ________________________________ __________________________________ Street: ________________________________ Street: __________________________________ ________________________________ __________________________________ City: ________________________________ City: __________________________________ Prov./State: _________________________ Prov./State:________________________________ Country: _______________________________ Country: _________________________________ Zip/Postal Code: _________________________ Zip/Postal Code: ___________________________

Country of Origin: ___________________________

Scientific Name and Common Name of the product: ________________________________________________ Description of the product: _____________________________________________________________________ Check one box Check one box Check one box Check one box Infectious: !!!! Hazardous: !!!! Animal origin: !!!! Used in vitro: !!!! Non-infectious: !!!! Non-hazardous: !!!! Non-animal origin: !!!! Used in vivo: !!!! Final Use of the product:_______________________________________________________________________

Signature Print name Date ** This declaration does not replace at anytime an import permit and/or an official veterinary certificate **

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