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Invoice for services provided under the National BSE Surveillance Program

Veterinarian

Enter here the UID associated with the BSE surveillance candidate. This UID was generated when you or somebody else provided all the required information in the BSE surveillance candidate questionnaire.

Address of Veterinary Clinic

DEADSTOCK COLLECTOR

Enter here the UID associated with the BSE surveillance candidate. This UID was generated when you or somebody else provided all the required information in the BSE surveillance candidate questionnaire.

Address of the company

PRODUCER

Enter here the UID associated with the BSE surveillance candidate. This UID was generated when you or somebody else provided all the required information in the BSE surveillance candidate questionnaire.

Payable to:

Declarations and signature

Terms and Conditions
  1. This agreement will be governed by an interpreted in accordance with the laws in force in the Province or Territory of the producer’s Premises Identification, the address of the veterinarian’s practice or the deadstock collection site, whichever is applicable.

  2. All samples collected from a BSE surveillance candidate having been assigned a unique number from the BSE surveillance history application shall become the sole property of the CFIA at the time the CFIA takes possession of the sample. The results of tests conducted by the CFIA on such samples remain the sole property of the CFIA.

  3. The CFIA will only contact the producer if the BSE test is positive. In the event of a BSE positive test result the CFIA will respond in accordance with the BSE hazard specific plan under the authority of the Health of Animals Act.

  4. Payments will be made in accordance with applicable Treasury board policies.

  5. The CFIA reserves the right to withhold and recover any and all payment should the producer, veterinarian or deadstock collector fail to comply with the terms and conditions under this agreement (as indicated by completing the checkboxes).

  6. The CFIA reserves the right to modify any term or condition of this agreement to reflect the conditions and requirements of its national BSE surveillance program and associated reimbursement policy as amended from time to time.

Protection of Information

The Business Number, Goods and Services Tax number or Social Insurance Number you provide on this document is collected for the Canadian Food Inspection Agency under the authority of the Income Tax Act for reporting purposes to the Canada Revenue Agency and personal information is collected for the purpose of processing electronic payments.

The personal information you provide on this document is also collected for the Canadian Food Inspection Agency under the authority of the Health of Animals Act for the purpose of managing the bovine spongiform encephalopathy (BSE) program.

Information may be accessible or protected as required under the provisions of the Access to Information Act or the Privacy Act and will be stored in personal information bank PSE 904 / PRN 941 for the Canadian Food Inspection Agency.

I have read and accept the Terms and Conditions applicable to this invoice.

I have read and accept the Protection of Information Statement applicable to this invoice.

The information provided in this invoice is true, accurate, and complete to the best of my knowledge and belief.

I agree to sign and approve the invoice.

If you need help with the invoice or want to report a problem with it, email cfia.BSEinvoice-factureESB.acia@inspection.gc.ca

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