Mail to:200 Front Street WestToronto ON M5V 3J1

OR fax to:416-344-46841-888-313-7373

Purchase Certificate (PC)Worksheet

Purchase Certificates are issued to a:

1.

2.

3.

Vendor or

Purchaser or

Vendor/Purchaser Representative who obtains vendors written authorization (which is a completed and signed

Direction of Authorization – Employer Accounts form 1797A).

Purchase Certificates are not issued for:

1.

2.

3.

4.

5.

6.

7.

Share purchases

Changes in legal name due to Articles of Amendment

Mergers/amalgamations

Receivers or receiver managers

Trustees in bankruptcy under the "Bankruptcy and Insolvency Act"

Person(s) who acquire a business (or part thereof) pursuant to an arrangement under the "Companies' Creditors

Arrangements Act"

Liquidators under the "Winding-up and Restructuring Act"

Vendor Information

Name Account No.

Address Will vendor continueto operate Yes No

City/Town Postal Code

Purchaser Information

Name Account No.

Address

City/Town Postal Code

Type of Sales TransactionDate of SalesTransaction

dd mmm yyyy

List of Assets (include attachments, if necessary)

Value of Assets(if partial sale)

Requestor Information

Name

Title

Firm Name Telephone

1238A (12/17)