BSF664 - Duty Free Shop Application/Amendment

The information provided on this form is collected under the authority of Section 24 of the Customs Act for the purpose of assessing new applications, renewals and amendments to existing duty free shop operations. The information is used by Canada Border Services Agency in order to approve and track requests for new applications and amendments and is used to conduct a risk assessment to insure the individual(s) have no criminal or customs infractions. The information may be disclosed internally for risk assessment purposes. Individuals have the right of access to and/or can make corrections of their personal information under the Privacy Act - Section 12. The information collected is described within Info Source under the Duty Free Shops Program - CBSA PPU 007 which is detailed at http://www.cbsa-asfc.gc.ca/.

• Licence to operate
• Licence amendment
• Amendment (Site/Building/Bond)
• Change in ownership
  • Applicant information
  • Name of applicant
  • Mailing address
  • Postal code
  • Telephone No.
• Duty free shop legal name
• Are site and building plans included?
  • Yes
  • No
• Site Address
• Business Number
• Licence to operate (Site applied for)
  • Airport
  • Land border
• Site Address
• Business Number
• Legal status of applicant (Provide proof of Canadian citizenship)
  • Corporation
  • Partnership
  • Sole proprietorship
  • Trust
  • Canadian citizen
  • Landed immigrant
  • Canadian company

  All shares must be owned by individuals who are Canadian citizens or landed immigrants. (Airports excluded)

• Licence Amendment (Provide certified copy of the amendment)
  • Change in name
  • Suspension
  • Cancellation
  • Reasons for amendment
• Amendment (Site/Building/Bond)
  • Changes requested
• CANADA BORDER SERVICES AGENCY (CBSA) USE ONLY
  • Approved
  • Not approved
• Comments
• Authorized signature and title / Date

Change in ownership structure (Provide certified copy of the amendment)

All shares must be owned by individuals who are Canadian citizens or landed immigrants.

Provide proof of Canadian citizenship. (Airports excluded)

• Name of applicant
  • Current
  • Revised
• Address of residence
  • Current
  • Revised
• Postal code
  • Current
  • Revised
• Telephone No.
  • Current
  • Revised
• Date of birth
  • Current
  • Revised
• Beneficial ownership interest
  • Current
  • Revised
    

Authorized signature and title

I hereby certify that all information provided with this application is true and I will conform with all the provisions of the CBSA laws and regulations, requirements and procedures for the operation of the duty free shops.

• Applicant's signature and title
• Licence no.
• Date

Date modified:

2012-12-18