K36A – Ships Stores Declaration and Clearance Certificate

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 (287 Kb) [help with PDF files]

  • Certificate no.
  • Date (YYYY-MM-DD)
  • Supplier name
  • Supplier address
  • Ship stores / Equipment furnishings / Repairs / Oceanic cable supplies
  • No. of packages or in bulk
    • Quantity and description of goods supplied
    • Remarks

1.  I hereby certify that the goods described above were received on board the ship/aircraft (Vessel name — Aircraft number) at (Place) on this (date) day of (month, year).

  • Signature (officer of ship or aircraft)
  • Title - Titre
  • Date

2.  I hereby certify that the information given above is true and complete in every respect and that the vessel/aircraft (Name of vessel/aircraft number) qualifies for ships stores under classification No.

  • Signature of supplier
  • Date

Clearance Certificate

(Do not use this area)

3. The ship/aircraft as specified above qualifies for ships stores as stated and cleared/departed on a voyage/flight to (place)

  • (A) For fishing ships show duration of voyage (days)
  • (B) In case of unusual delay in clearance explain:
  • Name of country (or customs office in Canada)
  • On (Date of clearance — departure)
  • Signature (Customs officer)

Instructions

(A) Section 2 is to be completed by inserting the classification number applicable to the ship or aircraft receiving supplies subject to drawback under the Goods Imported and Exported Refund and Drawback Regulations.

(B) Original of this form is required for drawback claim.

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