E571 – Late Accounting Penalties Application for Waiver, Cancellation

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 (52 Kb) [help with PDF files]

Please submit in duplicate and attach supporting documentation.

  • Broker (if applicable)
  • Releasing office code
  • Importer name
  • Transaction number(s)
    • Transmission date and time (For CADEX and CUSDEC transactions)
  • Reason for request
  • Manager's name (please print)
    • Telephone No. and Extension
    • Fax No.
    • Signature 
    • Date 
  • Refund of penalties paid
    • Central payment office
    • K84 payment date
    • Mail cheque to
    • Customs stamp
  • CBSA use only
    • Request granted / Request not granted / Under consideration by Headquarters
    • Refund amount
    • Comments
    • Name (please print)
    • Signature
    • Date
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