Canadian Chicken Licensing Regulations

(This form is to be prepared and signed by the primary processor.)

(Primary processor) declares that the following products(s), slaughtered at our facility, has/have been purchased by and is/are being claimed by the purchaser to meet the purchaser’s market development commitment for period A-:

• Return to footnote ⁽¹⁾Canadian Food Inspection Agency

Authorized Officer: (Signature)

Name:

Position: DATE:

Within seven (7) days of signature of this form, the primary processor must submit:

• - Copy 1 to Chicken Farmers of Canada, 1007-350 Sparks Street, Ottawa, ON K1R 7S8

• - Copy 2 to the Provincial Commodity Board

• - Copy 3 to the processor claiming the product(s)

Copy 4 is to retained by the primary processor for his or her own records.