Form: Request for temporary import and export certificate

Consult the information sheet for help with filling out this request.

All details of this application will be treated as confidential.

How would you like to receive the certificate?

For the certificate to be sent by courier, supply the courier company name and your account number:

Courier company: [empty space]

Courier account number: [empty space]

(Note: only Fedex or Purolator is supported)

Part 1: Applicant information

Name: [empty space]

Name of business or organization (if applicable): [empty space]

Address (number and street): [empty space]

Post Office Box: [empty space]

City: [empty space]

Province/Territory/State: [empty space]

Country: [empty space]

Postal Code/Zip code: [empty space]

Phone number: [empty space]

Email address: [empty space]

Part 2: Information on the foreign Musical Instrument or Traveling Exhibition certificate

Note: A copy (scan or photo) of the foreign certificate must be submitted with this application.

Part 3: Information on stay in Canada

I hereby certify that I am authorized to submit this application and that the information submitted is complete and accurate to the best of my knowledge.

Send to

Signature of Applicant: [empty space]

Date: [empty space]

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