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[]
[]
["Attestation Form\n for fuel intended for consumption outside Québec"]
[" "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DCC-PD (2024-1)"]
["A) Identification of the parties"]
["Fuel distributor:"]
[null,null,null,null,null,null,null,null,"Name of Distributor"]
["Customer who acquired fuel intended for consumption outside Québec (Customer) "]
["Name of customer:"]
["Customer representative:"]
["Title:"]
["Address:"]
[]
["Phone and fax:"]
["Email:"]
[]
["B) Period covered,  i.e. Distributor's last fiscal year preceding March 31, 2024."]
[null,null,"From:",null,"/",null,"/",null,null,null,"To:",null,"/",null,"/"]
[null,null,null,"Day / Month / Year",null,null,null,null,null,null,null,"Day / Month / Year"]
[]
["C) Volumes of fuel acquired in Québec by the Distributor's customer for consumption outside Québec during the period"]
[]
["Product",null,null,null,null,null,"Volumes \nintended for consumption outside Québec\n(in thousands of litres, use a comma ( , ) as decimal separator)"]
["1. Gasoline1"]
["2. Gasoline including Ethanol2"]
["3. Minus: portion of Ethanol of E103"]
["4. Total Gasoline (line 1 to 3) : ",null,null,null,null,null,{"$f":"SUM(G25:S27)","v":0}]
["Diesel fuel"]
["Light heating oil"]
["Heavy heating oil"]
["Propane"]
[]
[]
[]
["1 Gasoline of all grade (regular, intermediate and premium) without any Ethanol"]
["2 All type of Gasoline E5, E10, E15, etc. that include Ethanol. Indicate the total of volumes for consoumption outside of Québec with the portion of Ethanol."]
["3 Subtract the portion of Ethanol included in the volumes of gasoline of the preceeding line. Exemple: 5%, 10%, 15%, etc. according to the content of Ethanol. "]
[]
["D) Customer's attestation"]
["I hereby attest that our company purchased from the indicated Distributor the volumes of fuel indicated above for consumption outside Québec, during the indicated period."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"/",null,"/"]
["Customer's signature",null,null,null,null,null,null,null,null,null,null,null,"Date  (Day / Month / Year)"]
[]
["Please convert this attestation to PDF format"]