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
- Business no.
- 1. Company name
- 2. Application: original/amended
- 3. Head office address
- 4. Postal/Zip code
- 5. Name and title of contact(s)
- 6. Telephone No.
- Security information
- 7. Surety bond
- 8. Government of Canada bond
- 9. Other (specify)
- 10. Name and address of guarantee company
- 11. Bond no.
- 12. Amount
- 13. Warehouse address
- 14 Postal code
- 15. Warehouse operator
- 16. Premises: Owned by applicant / Leased by applicant
- 17. Distance from customs office
- 18. Name of lessor
- 19. Goods to be warehoused will be imported by: Applicant only / Applicant and others
- 20. Type of goods to be warehoused
- Imported in bond
- Imported in bond - alcohol
- Goods needing permits or other government requirements
- Domestic in bond - tobacco (ships' stores)
- Deemed exported (section 89(3), Customs Tariff)
- Other designated goods / Autres marchandises désignées
- Note: A valid permit issued by the proper provincial liquor authority is required before warehousing intoxicating liquor.
- 21. Goods to be ex-warehoused for
- Transfer in bond
- Ships stores
- Sale to diplomats
- 22. Siganture of applicant
- 23. Title
- 24. Date (yyyy-mm-dd)
Do not use this area
- Premise examined
- Meets requirements / Does not meet requirements
- Recommended for approval / Not recommended for approval
- For Chief officer of customs
- Approved / Amended / Not approved
- For Minister of National Revenue
- Licence No.
Note: Until such time as the application is approved and a licence number is allocated, this does not constitute a valid licence.
Privacy Statement - The information you provide in this document is collected under the authority of Sections 91 to 100 of the Customs Tariff, Section 23 of the Financial Administration Act (FAA), Section 70 of the Excise Tax Act and Section 173 of the Excise Act, 2001 for the purposes of determining eligibility for the Customs Bonded Warehouses (CBW) Program. The information may be disclosed to the Canada Border Services Agency (CBSA) - Programs Branch for the purposes of program evaluation, security and reporting purposes. Client 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.
Failure to provide the information requested on this application may result in the rejection of the application. Individuals have the right of access to and/or can make corrections of their personal
information under the Privacy Act. The information collected is described within Info Source under the Customs Bonded Warehouses (CBW) Program Personal Information Bank CBSA PPU
1405 which is detailed at http://www.cbsa-asfc.gc.ca.
Completion instructions – see also customs memorandum D7-4-4
1 The legally registered name of the company as shown on the security posted and, in the case of limited companies, as shown on the corporate seal.
2 Indicate the type of application by placing a checkmark ( ) in the applicable
3, 4 The full mailing address of the corporate head office including the postal or zip code. This address will be used for all correspondence concerning the application, and, after authorization is granted, all correspondence concerning the operations of the company.
5, 6 Provide the name, title, and telephone number of the person(s) who should be contacted in regards to the general operations of the company. If the address(es) differs from the head office address, provide the address(es). Use an additional page if necessary.
7 Indicate with a check mark ( ) if a surety bond from a guarantee company or financial institution is posted as security.
8 Indicate with a check mark ( ) if Government of Canada bonds are posted as security.
9 Indicate with a check mark ( ) if security other than a surety or Government of Canada bond is posted. Identify the type of security being posted, i.e., cash or certified cheque.
10 When surety bonds are posted as securtity, provide the full, legally registered name of the guarantee company or financial institution which issued the bond. Where applicable, provide the head office address of the grarantee company or financial institution. If not known, leave blank.
11 Where applicable, indicate the bond number of the surety bond.
12 Provide the amount of security.
13,14 The full mailing address of the warehouse including the postal code.
15 Indicate the name of the person or company operating the warehouse, if different from field 1.
16 Indicate with a check mark ( ) the appropriate box.
17 Meters/kilometers or yards/miles.
18 Provide name of lessor, if applicable.
19 Indicate with a check mark ( ) the appropriate box. Only one may be marked.
20 Indicate with a check mark ( ) the appropriate box(es).
21 Indicate with a check mark ( ) the appropriate box(es).
22 The application must be signed by an authorized official of the company.
23 Provide the title of the official signing the application.
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