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 C when completed
Please complete for each participating subsidiary, plant or location.
Fax the completed application form to Statistics Canada at: 1-888-269-5305 or (613) 951-6823.
- 1. Application date (YYYY-MM-DD)
- 2. Company name
- 3. Location of plant (if applicable)
- 4. Please select the applicable business type(s)
- Freight forwarder
- If a service provider is completing the form, the service provider information in fields 5, 6 and 7 must be completed.
- 5. Service provider name
- 6. Licence no.
- 7. Authorization ID
- Operating unit information – Please complete for each participating subsidiary, plant or location.
- 8. Operating name (if different than name stated above)
- 9. Business no. – The exporter's BN must be obtained from the Canada Revenue Agency by calling 1 800 959-5525.
- 10. Address
- City, province/state, country
- Postal/zip code
- 11. Contact name
- 12. Title
- 13. Telephone no.
- 14. Fax no.
- 15. E-mail address
- Commodity exported – List the commodities expected to be exported (additional pages may be attached if necessary).
- 16. Commodities
- 17. HS 10 digit code (if known)
- 18. Authorized signature
- 19. Date
- For government use only
- Licence no. – The licence no. is that of the person completing the form.
- Exporter's authorization no.
- Date modified: