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.
PROTECTED B when completed
- Importer name and address
- Business no.
- Postal/Zip Code
- Transaction no.
- GST registration no.
- Page (number) of (number
- Office no.
- Original transaction no.
- (YYYY-MM-DD)
- Date received
- Sub HDR no.
- Mail to:
- Postal / zip code
- Security no.
- Country of origin
- Place of export
- Tariff treatment
- Direct shipment date (MM-DD)
- Crcy. code
- Time limit
- Line
- Description – as accounted for
- Special authority
- Classification no.
- Tariff cd
- Quantity
- U/M
- VFD CD
- SIMA CD
- Customs duty rate
- E.T. rate
- GST rate
- Value for currency conversion
- Value for duty
- Customs duties
- SIMA assessment
- Excise tax
- Value for tax
- GST
- 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
- Customs duties
- SIMA assessment
- Excise tax
- Sub total
- GST
- Interest
- Amount due Receiver General for Canada
- Amount due claimant
- Date modified: