A23 - Delayed Baggage Report

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Protected A when completed


Privacy Act Statement

The information you provide in this document is collected under the authority of the Customs Act - Section 12 for the purpose of determining the admissibility, duty and tax treatment of the goods you are importing. The information may be disclosed to Air Carrier agents and baggage handling companies for the purposes of presenting your goods for examination by the Canada Border Services Agency (CBSA).

Failure to complete this form may result in punitive action including seizure of your goods. Individuals have the right of access to, the protection and correction of their personal information under the Privacy Act - Section 12. The information collected is described under the Personal Information Bank Delayed Baggage Report CBSA PPU 1109 which is detailed at www.infosource.gc.ca.

To be completed by carrier agent

To be completed by traveller

Returning Residents Only

Non-residents Only


I certify that the information given above is true and complete and I authorize the carrier mentioned above to open my baggage on my behalf for customs examination.

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