BSF987 - Mass Adjustment Request Form

Protected B when completed

You must complete and upload this form into the CARM Client Portal as part of your mass adjustment case submission.

• CARM Case Number
• CBSA Verification Number (if applicable)
• Importer's BN/RM
• Location of Books and Records
• Authorized agent (as per D1-6-1) - If Applicable
• Contact Information (email/telephone number)
• The adjustments presented in this mass adjustment case are:
  • Amount Owing to CBSA or Revenue Neutral Changes
  • Amount Resulting in Refund
• The adjustments submitted via mass adjustment case are presented under which reason code(s)?
  • Reason Code 1
  • Reason Code 2 (if applicable)
  • Reason Code 3 (if applicable)
• Reason and Justification for Adjustment Request/Additional Information:

Declaration

• Name of claimant or service provider attesting to the declaration
• Date of Declaration
• Please check the declaration boxes below
  • I read and understand the above statements
  • I confirm the reason code(s) selected apply to all CAD lines included in the mass adjustment case
  • I declare that the information presented in CARM case number _________ is true, accurate and complete.

Note: The case communication language will be based on the importer's language preference in the CARM Client Portal.

Privacy Statement

The information you provide in this document is collected under the authority of section 17, 32, 74 or 76 of the Customs Act, and section 96 of the Special Import Measures Act for the purpose of collecting trade data and assessing duties and taxes on imported commercial goods. The information collected may be disclosed to Statistics Canada for the purposes of Import reporting data, and to the Canada Revenue Agency for the purposes of Business Number and Import / Export accounts.

If the required information is not provided, it will result in your declaration or adjustment request not being processed by the CBSA.

Under the Privacy Act, individuals have the right to access and make corrections to their personal information. The information collected is described within the Information about Programs and Information Holdings (previously Info source) under the Accounts receivable ledger Personal Information Bank CBSA PPU 1501, which is detailed within the Information about Programs and Information Holdings (formerly Info Source). 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.

Instructions

For instructions on how to submit to a Mass Adjustment Request refer to Memorandum D17-2-1: Adjusting Commercial Accounting Declarations.