CUSTOMS SELF ASSESSMENT IMPORTER APPLICATION - PART 1

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1 Canada Customs and Revenue Agency Agence des douanes et du revenu du Canada 3URWHFWHGZKHQFRPSOHWHG This information is being coected according to the provisions of the Access to Information Act. It is being stored in the Acceerated Commercia Rerease Operations Support System (ACROSS) under Program Record Number RC CTA 125. CUSTOMS SELF ASSESSMENT IMPORTER APPLICATION - PART 1 The Customs Sef Assessment (CSA) program offers approved importers the benefits of: a streamined accounting and payment process for a of their imported goods; and a streamined cearance option for CSA eigibe goods when an approved carrier and registered driver are invoved. Do you quaify for the CSA program? You may quaify for the CSA program if you: are resident in Canada; have at east a two years history of activey importing; are without contraband or major commercia infractions; are prepared to invest in your business systems; and, can provide senior management representation that your business processes and systems wi support the CSA program requirements. How Do you appy for the CSA program? There are three parts to the CSA appication process. You must receive approva from the CCRA for each part before moving on to the next. Part I You wi provide basic information about your business structure and activities. The CCRA wi then conduct a risk assessment of your company Part II You wi have to document your commercia processes and audit trais. Part III You wi be asked to sign a cient undertaking. This wi soidify your partnership with the CCRA. To begin, an authorized officer of your company must compete the attached Part I appication forms and send them to the regiona director of the customs office nearest your head office. See the ist of customs offices at the end of this appication. Do not proceed to Part II unti you have received CCRA approva of your Part I appication. te The CCRA reserves the right to request additiona information for the purposes of this appication process. Need more information? If you woud ike more information about the CSA program, see the CSA Participants Guide or ca the customs office nearest your head office. Pease see the ist of customs offices at the end of this appication. E646 E (Ce formuaire existe aussi en français)

2 Canada Customs and Revenue Agency Agence des douanes et du revenu du Canada CUSTOMS SELF ASSESSMENT IMPORTER APPLICATION - PART 1 3URWHFWHGZKHQFRPSOHWHG This information is being coected according to the provisions of the Access to Information Act. It is being stored in the Acceerated Commercia Rerease Operations Support System (ACROSS) under Program Record Number RC CTA 125. Section A Appicant Identification 1. Appicant Language of correspondence: Engish French Business Number (BN) Lega business name Posta code 2. Maiing address (if different from above) City Province Posta code 3. Cient ownership type corporation soe proprietor partnership other (specify) 4. Trading, operating, or partnership names(s) 5. Web site 6. Dun and Bradstreet number 7. Canadian Standard Industria Code (SIC) 8. Briefy describe the company s key business activities and products (provide a separate sheet if more space is required). 9. CSA Last name First name Language of correspondence: Contact name Engish French Tite Emai address Teephone number ( ) Fax number ( ) Contact maiing address (if different from above) City Province Posta code 10. Approximatey how many empoyees are there in your company in Canada? E646E -2-

3 11. Identify a Canadian divisions of your company. Space has been provided for 2 divisions. If you need more space, pease copy this page and attach copies to this appication. Business Number (BN) and RM account identifier Lega business name Posta code Trading or operating name(s) Web site Dun and Bradstreet number Canadian Standard Industria Code (SIC) Is the division responsibe for its own procurements? Does the division import goods into Canada? <HV 1R Briefy describe the key business activities or business ine, and products of this division. Business Number (BN) and RM account identifier Lega business name Posta code Trading or operating name(s) Web site Dun and Bradstreet number Canadian Standard Industria Code (SIC) Is the division responsibe for its own procurements? Does the division import goods into Canada? <HV 1R Briefy describe the key business activities or business ine, and products of this division. 12. If appicabe, pease ist a other BN and RM account identifiers and names that you have not identified above. %XVLQHVV1XPEHU%1DQG50DFFRXQWLGHQWLILHU %XVLQHVVQDPH -3-

4 Section B Additiona Appicant Information 1. Pease describe any interna poicies your company has in pace to minimize the risk of crimina activities (e.g., hiring poicies, and reporting procedures for suspicious or crimina activities). Incude copies of standard operating procedures or interna bookets if they are avaiabe. Pease incude the effective date of your documents and practices. 2. a) Do you use foreign trade zone(s) in the United States in your import process? b) If yes, ist the ocation of the foreign trade zone(s) and describe the process (e.g., repacking, further manufacturing) and origin of those goods. Location Process Origin 3. a) Does your company operate its own feet for importing goods into Canada? b) If yes, provide its carrier code(s). If you intend to use CSA cearance, your transportation operation shoud appy separatey, as a carrier 4. a) Do you have any agreements or arrangements with other government departments or agencies for meeting their reease and cearance requirements? b) If yes, pease describe the arrangement for each government department or agency, as it may reate to your imports under CSA cearance option. Provide a separate sheet if more space is required. -4-

5 Section C Certification Pease forward the competed appication, and a chart of your corporate structure to the regiona director of the customs office nearest your corporate head office. As an authorized officer of the appicant company, I certify that the information given on this form and any document attached is, to the best of my knowedge, true, accurate, and compete. Authorized person s name Signature Tite or office Date (YYYY/MM/DD) Competing this appication form does not constitute approva to act as a CSA importer. Ony after you have successfuy competed the three steps of the appication process wi you be considered an approved CSA importer. Do not make any CSA-specific investments to your business systems unti the appication process is compete. Customs offices CSA Appication Regiona Director Dunsmuir Street Vancouver BC V6B 5R4 Teephone: (604) CSA Appication Regiona Director 269 Main Street Winnipeg MB R3C 1B3 Teephone: (204) CSA Appication Regiona Director 11th foor, 333 Laurier Avenue West Ottawa ON K1A 0L5 Teephone: (613) CSA Appication Regiona Director 1 Front Street, West P.O. Box. 10, Station A Toronto ON M5W 1A3 Teephone: (416) CSA Appication Regiona Director 4th foor, 400 Pace d Youvie Montréa QC H2Y 2C2 Teephone: (514) CSA Appication Regiona Director 9th foor, Raston Buiding P.O. Box 3080, Station Parkane Centre Haifax NS B3J 3G6 Teephone: (902)

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