Export Import Price Report

Month

Confidential when completed.

Collected under the authority of the Statistics Act.
Revised Statutes of Canada, 1985, Chapter S19.
Completion of this questionnaire is a legal requirement under this act.

Survey purpose

The prices you report are essential to the production of indexes measuring the movement of prices in the Canadian economy. In order to enhance the information you provide in this survey, Statistics Canada plans to combine the responses relating to your organization with the information you previously provided on this survey.

The reporting form sets out our request for price information for the period shown. We urge you to read the instructions carefully and fill in the requested information.

Should you require further information with respect to this report, please contact the Producer Prices Division commodity specialist indicated on the reverse side. Please feel free to call collect or call 1-888-951-4550 for general enquiries.

The information and data pre-coded on this form reflects the respondent's preference.

Confidentiality

The Statistics Act protects the confidentiality of information collected by Statistics Canada.

Fax or other electronic transmission disclosure

Statistics Canada advises you that there could be a risk of disclosure during facsimile or other electronic transmission.

However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.

If necessary, please correct the pre-printed information below.

• Legal name
• Business name
• Operating name
• Attn:
• Street
• City, Province
• A1A 1A1

Respondent :

Contact :
Commodity Specialist
(613) 951-

To complete this price report:

1) In Box A enter the Transaction Price in effect on the 15^th of the month indicated.

2) In Box B enter “NT” if no transaction occurred and give an estimate in Box A for the transaction prices.

3) If there is any change in the Description of product and/or Transaction description please amend.

Product ID:

Commodity Description:

Description of Product:

Transaction Description :
C1:
C2:
C3:
C4:

Table

Date of last reported price change: 2010-01			C1 to C4 Transaction description as specified above				Circle reasons for price change							Further explanation of price change (pertinent market information)
Date:	Box A	Box B	C1	C2	C3	C4	D
2008-12							1	2	3	4	5	6	7
2009-01							1	2	3	4	5	6	7
2009-02							1	2	3	4	5	6	7
2009-03							1	2	3	4	5	6	7
2009-04							1	2	3	4	5	6	7
2009-05							1	2	3	4	5	6	7
2009-06							1	2	3	4	5	6	7
2009-07							1	2	3	4	5	6	7
2009-08							1	2	3	4	5	6	7
2009-09							1	2	3	4	5	6	7
2009-10							1	2	3	4	5	6	7
2009-11							1	2	3	4	5	6	7
2009-12							1	2	3	4	5	6	7
Reasons for price change: 1. Material costs 2. Labour costs 3. Competitive factors 4. Physical content 5. Terms of sale 6. Exchange rate 7. Others - describe

General information

Confidentiality

Your answers are confidential.

Statistics Canada is prohibited by law from releasing any information from this survey which would identify a person, business, or organization, without their prior consent. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation. Therefore, for example, the Canada Revenue Agency cannot access identifiable survey data from Statistics Canada.

These survey data will only be used for statistical purposes and will be published in an aggregate form only.

Record Linkage

To enhance the data from this survey, Statistics Canada may combine it with information from other surveys or from administrative sources.

Comments

We welcome your comments below. Please be assured that we review all comments with the intent of improving the survey.

Thank you for completing this questionnaire. Please retain a copy for your records.

Visit our website at www.statcan.gc.ca