1. Vendor (name and address) *
2. Date of direct shipment *
3. Other references * (include purchaser's order No.)
4. Consignee (name and address) *
5. Purchaser's name and address *(if other than consignee)
6. Country of transhipment *
7. Country of origin of goods

IF SHIPMENT INCLUDES GOODS OF DIFFERENT ORIGINS ENTER ORIGINS AGAINST ITEMS IN 12.
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8. Transportation: Give mode and place of direct shipment to Canada *
9. Conditions of sale and terms of payment (i.e. sale, consignment shipment, leased goods, etc.)
10. Currency of settlement
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11. Number of packages
12. Specification of commodities (kind of packages, marks and numbers, general description and characteristics, i.e., grade, quality)
13. Quantity (state unit)*

Selling price

14. Unit price*
15. Total*

Total weight

16. Net Weight*
Gross
17. Invoice total*
18. If any of fields 1 to 17 are included on an attached commercial invoice, check this box
Commercial Invoice No.
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19. Exporter's name and address (if other than vendor) *
20. Originator (name and address) *
21. CCRA ruling (if applicable)
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22. If fields 23 to 25 are not applicable, check this box
23. If included in field 17 indicate amount:
(i) Transportation charges, expenses and insurance from the place of direct shipment to Canada *
(ii) Costs for construction, erection and assembly incurred after importation into Canada *
(iii) Export packing *
24. If not included in field 17 indicate amount:
(i) Transportation charges, expenses and insurance to the place of direct shipment to Canada *
(ii) Amounts for commissions other than buying commissions *
(iii) Export packing *

25. Check (if applicable):
(i) Royalty payments or subsequent proceeds are paid or payable by the purchaser *
(ii) The purchaser has supplied goods or services for use in the production of these goods *
Enter the contents of image*
If this shipment is to be delivered to the consignee without recourse on the consignor, the consignor needs to sign the appropriate statement, which is in the fine-print area of the BOL.