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Notice to Importers

Chicken and Chicken Products – Supplemental Imports (Items 96 to 104 on the Import Control List)

Appendix 4 - Statement of Inventory Reconciliation

Statement of Inventory Reconciliation for the Period [TYPE IN DATES]

Statement of Inventory Reconciliation
Canada Border Services Agency (CBSA) determinationa numberProduct NumberProduct NameTotal Unit Weight (in grams)Chicken Per Unit (in grams)Opening inventory (Number of Units)Total Units Produced and Sold during the authorized periodClosing inventory (Number of Units)Chicken used during the authorized period (in eviscerated equivalent kg)
F55566123Chicken Kiev1304590150456.75

Certified correct by (signature):  ______________________________

Certified correct by (name, please print):  ______________________________

Name of firm (typed):  ________________________________

Senior Partner Responsible:  ___________________________

Senior Partner Signature:  ___________________________

Province:  ________________________________

Membership number with

Provincial Professional Association: