B23 - Investigations Division – Worksheet

Protected B when completed

• Exhibit no.
• Page (number) of (number)
• CBSA office
• Worksheet no.
• CIIMS no.
• Original transaction no.
• Dated (YYYY-MM-DD)

Note: The information on this form is collected to maintain records and is protected under the provisions of the Privacy Act. The form is stored in a personal information bank, Investigations record No. RCC PPU 020.

• Importer number/name, address
• Vendor number, name, address

• Page no.
• Line no.
• Description
• Special authority
• Should be
  • Classification no.
  • Quantity
  • Rate of duty
  • Value for currency conversion
  • Exch. date (DD-MM)
  • Exch. rate
  • Value for duty (Can. dollars)
  • Customs duties
  • Duty-paid value
  • Excise tax
  • GST
• As entered Tel que déclaré
  • Classification no.
  • Quantity
  • Rate of duty
  • Value for currency conversion
  • Exch. date (DD-MM)
  • Exch. rate
  • Value for duty (Can. dollars)
  • Customs duties
  • Duty-paid value
  • Excise tax
  • GST
• Difference

• Purchase order
  • Date
  • No
• Receipt notice
  • Date
  • No
• Commercial invoice
  • Date
  • No
  • Amount
• Method of payment
  • Method
  • Date
  • Reference
  • Amount
  • Other

• Reference identification
• Total amount demanded
• Amount subject to forfeiture

Date modified:

2013-04-03