BSF613 – Summary Reporting Program Application Form

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.

PDF (1.3 Mb) [help with PDF files]

Protected B when completed

Important Information

For CBSA use only - Pour l'utilisation de l'ASFC seulement

Privacy Notice

The information on this form is collected under the authority of the Customs Act ­Section 95 for the purpose of administering the Canada Border Services Agency (CBSA) Export Program. The personal information on this form is protected in accordance with the Privacy Act. The information may be disclosed to internal and external Government of Canada bodies for the purposes of enforcement, safety, security, statistics and intelligence.

You have the right to access and/or to correct your personal information under the Privacy Act ­Section 12. The information collected is described under the Personal Information Bank Export Program CBSA PPU 1103 which is detailed at http://www.infosource.gc.ca.

Completion Instructions

Original, Amendment(s) to Field(s): check the appropriate box to indicate whether your application is the original document or you are making an amendment. If it is an amendment, indicate the appropriate field(s) that you are amending.

Authorization Number: Insert your existing SUM authorization number if you have one. If not, leave this blank.

Continuation sheet(s) may be included to provide the information found in fields 2, 3, 4 and 5.

Field No. 1. Enter the Exporter's Name, Address and Business Number. The Business Number (BN) is the federal government assigned number, including the six digit RM account identifier, of the company or person that exports the goods or causes them to be exported. Note: When an Administrative Monetary Penalty is issued, it will be assessed against the company whose BN appears on the form. To request a BN, visit the Canada Revenue Agency Web site at http:// www.cra-arc.gc.ca/tx/bsnss/tpcs/bn-ne/menu-eng.html or call 1 (800) 959-5525.

Field No. 2. If the goods are of Canadian origin, state the province from which the goods were grown, mined or manufactured. If not, state the country. If the goods are further processed imported goods or are imported goods being exported, state the province from which the goods are exported. In addition, enter the complete description of the goods in normal trade terms, and the Canadian 8-digit harmonized system export code or Canadian 10-digit code.

Field No. 3. State the place(s) of exit through which the goods are expected to leave Canada and the final mode of transportation by which the goods are transported out of Canada. List all the expected places of exit and modes of transport.

Field No. 4. Show the countries of final destination where the goods are to be consumed, further processed or manufactured, as known at the time of export.

Field No. 5. Check the appropriate box that applies. If your company exports goods subject to export controls, show the country of final destination where the goods are to be consumed, further processed or manufactured, as known at the time of export. In addition, enter the complete description of the goods, in normal trade terms, and the Canadian 8-digit harmonized system export code or Canadian 10-digit code.

Field No. 6. Show the name of the carrier that transports the goods out of Canada.

Field No. 7. Check the appropriate box that applies. If applicable, indicate all methods that your company currently uses to report exports.

Field No. 8. Provide the name, title, business telephone number, mailing and e-mail addresses of the person responsible for completing the application. Please sign and date.

Field No. 9. Provide the name, title, business telephone number, mailing and e-mail addresses of the Company President, Vice-President or Chief Financial Officer. Please sign and date.

Sample Report Format

ABC Company BN - 123456789RM0001
Summary ID- 9999
Contact Name - Jane Doe
123 Apple Street
Ottawa, Ontario K2G 1T3
T - (613) 123-4567
F - (613) 123-4568
email apple@abccompany.com

Date modified: