Export Compliance Pesticide Treatment Certificate

Certificate Number Date of Issue
Exporter Name Importer Name
Exporter Address Importer Address
Country of Origin Country of Destination

Pesticide Treatment Details

Description of Commodity
Quantity
Treatment Type
Chemical Used
Concentration
Duration of Treatment
Date of Treatment
Location of Treatment
Facility Name

This is to certify that the commodity described above has been treated as specified and complies with the export regulations.

Authorized Signatory
Date