B2 – Canada Customs – Adjustment Request

A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.

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PROTECTED B when completed

  1. Importer name and address
    • Business no.
    • Postal/Zip Code
  2. Transaction no.
  3. GST registration no.
  4. Page (number) of (number
  5. Office no.
  6. Original transaction no.
  7. (YYYY-MM-DD)
  8. Date received
  9. Sub HDR no.
  10. Mail to:
    • Postal / zip code
  11. Security no.
  12. Country of origin
  13. Place of export
  14. Tariff treatment
  15. Direct shipment date (MM-DD)
  16. Crcy. code
  17. Time limit
  18. Line
  19. Description – as accounted for
  20. Special authority
  21. Classification no.
  22. Tariff cd
  23. Quantity
  24. U/M
  25. VFD CD
  26. SIMA CD
  27. Customs duty rate
  28. E.T. rate
  29. GST rate  
  30. Value for currency conversion
  31. Value for duty
  32. Customs duties
  33. SIMA assessment
  34. Excise tax
  35. Value for tax
  36. GST
  37. Docs attached
    • Justification for request
    • A (type of request) under (legislative reference)
    • Explanation:
    • Declaration
    • I (please print name) of (importer/agent) declare the particulars of this document to be true, accurate and complete
    • Date
    • Signature
    • Telephone number
  38. Customs duties
  39. SIMA assessment
  40. Excise tax
  41. Sub total
  42. GST
  43. Interest
  44. Amount due Receiver General for Canada
  45. Amount due claimant
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