PST EXEMPTION CERTIFICATE
[  ]      BLANKET
         
Business Name:        
           
Business Address:        
           
Vendor Permit Number (If Applicable):        
           
Nature Of Business:        
           
Reason For Claiming Exemption:        
         
         
I claim exemption from Ontario retail sales tax under the provisions of the Retail Sales Tax Act on the following goods, or
taxable services, contracts of insurance or benefits plan.
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         

Signature Of Authorized Person
Date
         
         

(PRINT) Name Of Authorized Person
Title
         
IMPORTANT
         
The person buying the goods or taxable service, or entering into a contract of insurance or benefits plans 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. The 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 the Purchase Exemption Certificate
Every person who makes a false statement on the Purchase Exemption Certificate or misuses the certificate is liable, if
convicted, to a fine of not less than $500.00 and 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.