B247 – CCFTA Verification Of Origin Questionnaire

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.

PDF (515 Kb) [help with PDF files]


The purpose of this questionnaire is to request that you provide the Canada Border Services Agency (CBSA), pursuant to subparagraph E-06(1)(a) of the Canada-Chile Free Trade Agreement (CCFTA), with the information used to determine the eligibility of the goods for the CCFTA preferential tariff treatment. This information is required to conduct a verification of the origin of specified goods imported into Canada, pursuant to section 42.1 of the Customs Act (hereinafter referred to as "the Act"), for which a claim for preferential tariff treatment was made on the basis that the goods originate, as a result of meeting a rule of origin under the CCFTA.

This questionnaire must be completed, signed and returned by the date specified in the covering letter accompanying this questionnaire. Failure to complete and return this questionnaire in the prescribed time and manner may, pursuant to subsection 42.1(2) of the Act, result in the denial of preferential tariff treatment under the CCFTA.


The CBSA may further verify the origin of the goods and/or determine the accuracy of any or all of the information provided in the completed questionnaire by sending a subsequent verification questionnaire or verification letter, and/or by conducting a verification visit in accordance with section 42.1 of the Act.

For additional information regarding the completion of this questionnaire, please refer to the Regulations. Information and/or clarification may also be obtained from the CBSA officer identified in the covering letter. The CBSA Customs D Memoranda are available at www.cbsa-asfc.gc.ca/menu/D-e.html; the Customs Tariff, at www.cbsa-asfc.gc.ca/general/publications/customs_tariff-e.html; and the Customs Act, at laws.justice.gc.ca/en/C-52/index.html.

The CBSA shall, in accordance with section 107 of the Act, protect the confidentiality of all confidential business information submitted in this questionnaire and shall not, under any circumstances, disclose such information to a third party without prior consultation with your company.

Instructions on the completion of the questionnaire

The information requested in this questionnaire may be received by the CBSA in any suitable format including electronic. For example, a bill of materials indicating the origin of materials and the respective supplier names and addresses instead of reproducing the information in the questionnaire will be acceptable to the CBSA.

If you are the exporter of the good being verified and relied on a certificate of origin or a written representation from the producer to prepare your certificate of origin, provide it, then complete section IV. For all other instances, complete all sections of the questionnaire. If intermediate materials were used in the production of the good, sections I to III must also be completed for each intermediate material.

This questionnaire must be completed, signed and dated by the exporter or producer of the goods/material or an individual who can certify as to the accuracy of the information provided in response to the questionnaire, as the case may be.

Where there is insufficient space in this questionnaire to adequately respond to a request for information, copy and attach the relevant page.


Protected C when completed

Section I – Exporter Information

Section II – Material(s) or Component(s)

Section III – Additional Information

Section IV – Certification

Print or type (except for the signature)

I certify that the information on this document is true and accurate. I agree to maintain, and present upon request, all records and documents necessary to support the representations made in response to this questionnaire. I understand that I am liable for any false statements or omissions made on or in connection with this document.

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