ONTARIO RETAIL SALES TAX
PURCHASE 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
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.  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 false statement on the Purchase Exemption Certificate of 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 the
tax that should have been paid, or that was evaded, of or to imprisonment for a term of not more than two
years of to both.