BSF664 - Duty Free Shop Application/Amendment

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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 customs infractions. The information may be disclosed internally for risk assessment purposes. Individuals have the right to access and to make corrections of their personal information under the Privacy Act, Section 12. The information collected is described within Information about programs and information holdings (formerly Info Source) under the Duty Free Shop Applicants Personal Information – CBSA PPU 007 which is detailed at CBSA Information holding Chapter. 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.

1A. Type of application

1B. Program account name

West Division Ouest (RM0001)
XYZ Inc (123456789)

In response to an advertised process

2. Applicable process number

3. Distance from the customs Control Area

4. Is the location fully in view of the CBSA Office?

5. Is the egress route past the point of no return?

6. Percentage of domestic goods

7. Percentage of local employment

8. Business size

Renewal of an existing licence

9. DFS Licence number being renewed

Amendment to an existing licence

10. DFS Licence number

11. Reason for change request (Select all that apply)

Yearly Security Update

12. Provide last year's highest inventory value

Duty Free Shop physical address

Type of DFS

13. Address line 1

14. Address line 2

15. City

16. Country

17. Province

18. Postal Code

19. Telephone No.

20. Facsimile No.

Mailing address (if different from physical address)

21. Care of Line

22. P.O. Box/R.R.

23. Address line 1

24. Address line 2

25. City

26. Country

27. Province

28. Postal Code

29. Telephone No.

30. Facsimile No.

31. Language preference

Books and records address

32. Address line 1

33. Address line 2

34. City

35 Country

36. Province

37. Postal Code

38. Telephone No.

39. Facsimile No.

40. Contact type

41. Title

42a. First name

42b. Last name

43. Email address

44. Telephone number

45. Facsimile number

46. Language preference

47. Applicant name

48. Applicant title

49. Premises

50. Name of lessor

51. Telephone No. of lessor

52. Facsimile No. of lessor

53. Email of lessor

54. Expiry date of lease (yyyy-mm-dd)

55. Is the DFS located in

56. If you selected a non-sterile environment, is a delivery agreement in place?

57. Bilingual service

58. Is there an off-site warehouse?

59. Do you have yearly or seasonal operations?

60. If you selected seasonal, identify the period the DFS is closed

61. Hours of service

62. List product lines both imported and domestic

63. Provide a general description of anticipated merchandise for each selected product line

64. Has a liquor license been obtained?

65. Expiry date of liquor license if applicable

66. Beneficial owner's name

67A. Is the beneficial owner at least 18 years of age?

67B. Canadian citizen or a permanent resident?

68. Has been convicted of a criminal offence for which they have not received a pardon?

69. 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.

70. First name

71. Middle name

72. Last name

Detailed Instructions

1a. Indicate the application type by placing a checkmark in the applicable option button.

1b. Provide the program account name that will be used in the CARM Client Portal.

2-8. If the application is in response to an advertised process, answers questions 2 to 8:

2. Application Process Number

3. Metres/kilometres or yards/miles

4. Yes or No

5. Yes or No

6. Percentage

7. Percentage

8. Number of employees

9. If the application is a renewal of an existing licence, provide the DFS Licence number being renewed.

10. If the application is an amendment to an existing licence, provide the existing DFS Licence number.

11. If the application is an amendment to an existing licence, indicate with a check mark(s) (  ) all reasons for the change request. Check all that apply.

12. If the application is for a yearly financial security update, provide last year’s highest inventory value.

Physical address

13-20. The full physical address of the duty free shop, including the postal code. Include the office telephone number and facsimile.

Mailing address (if different from physical address)

21-31. The full mailing address of the corporate head office including the postal code. Include a telephone number, facsimile, care of line and a language preference. This address will be used for all correspondence concerning the application, and, after authorization is granted, all correspondence concerning the operations of the company.

Books and records address

32-39. The full address of where the books and records are stored, the postal code, telephone number and facsimile.

40-46. Provide the type, title, first name, last name, telephone number, facsimile number (optional), preferred language of correspondence and email address of person(s) who should be contacted regarding this application.

47-48. Provide information about the applicant.

49. Indicate with a check mark (  ) if the premises are owned by applicant or leased by applicant.

50-54. If leased, provide the name, telephone number, facsimile, and email of lessor, as well as the expiry date of the lease.

55. Indicate with a check mark (  ) if the DFS is located in a sterile or non-sterile environment.

56. If a non-sterile environment was selected, indicate with a check mark (  ) if a delivery agreement is in place.

57. Indicate with a check mark (  ) if the duty free shop provides bilingual services.

Detailed Instructions

58. Indicate with a check mark (  ) if there is an off-site warehouse.

59. Indicate with a check mark (  ) if you have yearly or seasonal operations.

60. If seasonal was selected, identify the period when the duty free shop is closed.

61. Provide the hours of service.

62. Indicate with a check mark(s) (  ) all the applicable product lines.

63. Provide a general description of anticipated merchandise for each selected product line.

64. Indicate with a check mark (  ) if a liquor licence has been obtained.

65. If you have a liquor licence, provide the expiry date of the licence.

66-68. Provide information about the beneficial owners.

69. Indicate with a check mark (  ) that the applicant has certified their agreement of the included text.

70-73. Provide the first name, middle name (if applicable), and last name of the applicant.

Note: This does not constitute a valid licence.

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