PST Application Form

IF BLANKET PLEASE CHECK  

COMPANY NAME:

COMPANY ADDRESS:

CITY:

POSTAL CODE:

PHONE:


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 :


DATE:

SIGNATURE

PRINTED NAME

IMPORTANT 

Please complete the above form, print the screen and fax signed form to us

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,

• the line beside the word "blanket" at the top of the form is checked; and 

• the purchase order refers to this purchase exemption certificate. any

person who makes a false statement on a purchase exemption certificate or misuses the certificate is liable, if convicted, to a fine of not less than $500 and an amount of not more than double the amount of 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.