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 A when completed
Please print in dark ink as illegible applications will be rejected. Any errors or omissions may delay the processing of your application. Refer to the instructions on reverse.
1. Legal business name
2. Operating/Trade Name
3. Language of correspondence
4. Physical address and postal code/zip code
5. Mailing address and postal code/zip code (if different from field 4)
6. Names and titles of contacts
7. Telephone no.
8. Cell phone no.
9. E-mail address
10. Web site address
11. Company Ownership Type (see instructions on reverse)
- Sole Proprietorship
12. CRA Business Number, must be 15 characters (see instructions on reverse)
13. Do you own and operate a locomotive?
14. Type of application
- Single trip bond
15. If you've checked bonded or single trip bond, complete this section.
- Surety Bond
16. Name and address of guarantee company
17. Bond no.
19. As an authorized officer of the applicant company, I certify that the information on this application and in any attached documents is, to the best of my knowledge, true and complete.
- Print name
- Position Title
- E-mail Address
20. Third Party Consent
I (name) authorize (name) to act on our behalf in all matters relating to the application for a carrier code. This authorization is valid until written notice from, (date).
21. Agent's name
22. Agent's telephone number
23. Agent's company name
24. Agent's e-mail address
Privacy Act Statement - The information you provide in this document is collected under the authority of Section 12(2) of the Customs Act and Section 4 of the Reporting of Imported Goods Regulations for the purpose of verifying applicant's identities to conduct carrier operations in Canada. The information may be disclosed to the Canada Border Services Agency (CBSA) - Programs Branch for the purposes of program evaluation, security and reporting purposes. Carrier client's information may also be disclosed to the Canada Revenue Agency (CRA) for the purposes of locating an individual in order to collect a debt owing to Her Majesty in right of Canada. The information may also be disclosed to the Royal Canadian Mounted Police (RCMP) and/or to investigative bodies specified in the Privacy Regulations - upon the written request - for the purposes of law enforcement/investigation. Under the law, failure to provide the information requested on this form may result in the rejection of the application. Individuals have the right of access to and the protection and correction of their personal information under the Privacy Act - Section 12. The information collected is described under the Carrier and Cargo Program Personal Information Bank CBSA PPU 045 which is detailed at www.infosource.gc.ca. Should you have concerns about the CBSA's handling of your personal information you have a right to file a complaint with the Privacy Commissioner of Canada.
Field 1 - Legal Business Name - The legally registered name of the company.
Field 2 - Operating/Trade Name - The name that the company operates under, if applicable. Please note it should NOT be a separate legal entity.
Field 4 - Physical Address - The complete address of the company's head office including the number, street, city, province/territory/state, country and postal code/zip code.
Field 5 - Mailing Address - The complete mailing address that will be used for all correspondence related to this application.
Field 6 - Names and Titles of Contacts - The authorized contacts for enquiries related to this application and the carrier code profile. They must be employees of the company, not third party agents. Additional space is provided on page 3.
Field 11 - Company Ownership Type - The carrier must provide as proof of ownership a photocopy of one of the following documents, in English or French, based on their company ownership type. 1)
Corporation: articles of incorporation or business registration documents. 2) Partnership: business
registration documents listing all partners. 3) Sole Proprietor: government issued photo identification. The CBSA reserves the right to request additional information to confirm the company's legitimacy. Please note that the application will not be processed if proof of ownership is not provided.
Field 12 - CRA Business Number - The business number is a 15 character identifier issued by the Canada Revenue Agency (CRA) (e.g. 123456789RM0001). For additional information please visit the CRA website at www.cra.gc.ca.
Field 14 - Type of Application - Indicate the application type. A non-bonded carrier must have the shipment released at the first point of arrival (i.e. the nearest customs office). A bonded carrier posts security with the CBSA to cover various situations such as the movement of goods inland for clearance, the movement of goods in-transit through Canada and to apply for a Trusted Trader Program.
Field 15 - Type of Security - General policies and procedures in relation to the posting of security for participation in CBSA bonded transactions can be found on the agency's website at www.cbsa.gc.ca within Memorandum D1-7-1, Posting Security for Transacting Bonded Operations. Surety and financial institution bonds must be made on form D120 Customs Bond. A sample of this form and completion instructions are available in the Memorandum.
Field 16 - Name and Address of the Guarantee Company - If a customs bond accompanies this
application, please provide the complete legal name and address of the guarantee company or financial
institution who issued the bond. Include the number, street, city, province/territory/state, country and
postal code/zip code.
Field 17 - Bond Number - Provide the bond number indicated on the customs bond.
Field 18 - Amount - Provide the amount of security indicated on the customs bond.
Field 19 - Certification - An authorized officer who has legal signing authority for the applicant company must sign. Authorized officers include: Chief Executive Officer, Chief Financial Officer, President, Vice President, Owner, Partner, Director or an equivalent title that allows the individual to legally bind the company to a written agreement. In the case of a sole proprietorship, only the owner may sign.
Field 20 - Third Party Consent - Complete only if the applicant wishes to nominate a third party representative to act on behalf of them in all matters concerning the application.
Non-bonded applications should be submitted to the following email address:
Bonded applications must be submitted by mail to:
Canada Border Services Agency
191 Laurier Avenue West, 12th floor
Ottawa, Ontario K1A 0L8
6. Names and titles of contacts
7. Telephone no.
8. Cell phone no.
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