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Blanket ___
Business Name: _______________________________________________________________________
Business Address: _____________________________________________________________________

Vender Permit Number (if applicable): __________________________________________________
Nature of Business: ________________________________________________________________
Reason for Claiming Exemption: ______________________________________________________
      I claim exemption from Ontario retail sales tax under the provision of the Retail sales Tax Act
      on the following goods or taxable services, contracts of insurance or benefits plan:

Signature of Authorized Person
(Print) Name of Authorized Person
The person buying the goods or taxable service, or entering into a contract of insurance or benefits plan for which an exemption is claimed must complete this certificate and give it to the supplier.
The supplier is to keep this form as stated in the regulations. This certificate is valid for four years if,
  • (a) the box beside the word 'blanket' at the top of the form is checked; and
  • (b) the purchase order refers to this Purchase Exemption Certificate.
Every person who makes a faise statement on a Purchase Exemption Certificate or misuses the certificate is liable, if convicted, to a fine of not less than $1,000 and an amount of not more than double the amount of the tax that should have been paid, or that was evaded, or to imprisonment for a term of not more than two years, or to both.