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
- Received from
- Name used by passenger
- FOSS ID no.
- On (Date - DD-MM-YYYY)
- At (Place of embarkation)
- Type of document
- Passport / Other (specified under R259)
- Document number
- Flight number
- Signature of passenger
- Signature of company official and employee I.D. number
- Date (DD-MM-YYYY)
Subsection 260(1) of the Immigration Regulations – If a transporter has reasonable grounds to believe that the prescribed documents of a person whom it carries to Canada may not be available for examination at a port of entry, the transporter must give the person a receipt for the documents and hold those documents until examination.
Subsection 260(2) of the Immigration Regulations – A transporter who holds the documents of a person must, when presenting the person for examination under paragraph 148(1)(b) of the Act, present the documents and a copy of the receipt.
Paragraph 148(1)(b) of the Immigration and Refugee Protection Act – A person who owns or operates a vehicle or a transportation facility, and an agent for such a person, must, in accordance with the regulations, hold the prescribed documentation of a person whom it carries to Canada until an examination begins, present the person for examination and hold the person until the examination is completed.
This form has been established by the Minister of Public Safety and may be reproduced locally. This is a receipt only. Under no circumstances should presentation of this form in lieu of travel documents result in the boarding of the holder.
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