B2G - CBSA Informal Adjustment Request

Part A - Importer Information

1. Importer name and address

• Name
• No
• Street
• Unit No.
• City
• Province
• Postal Code

2. Telephone number

• Residence
• Business

3. CBSA import receipt number (Please attach original import document)

4. Date of importation (YYYY-MM-DD)

5. Description of goods

6. Reason for refund/adjustment request

1. Goods returned to sender/exported
2. Incorrect value assessed
   Value should be:
3. Goods incorrectly described or classified
   Should be:
4. Other (specify)

7. Please provide a brief explanation of your request and attach the original import document. If the goods have been returned to the sender, attach documents to support your request, such as a credit note from the vendor and proof of export. If the goods were incorrectly classified, descriptive literature or an invoice from the vendor should be attached.

8.Declaration
I declare the particulars of this document to be true, accurate and complete.

Signature
Date

Privacy Act Statement - The information you provide in this document is collected under the authority of Sections 59(1)(a)(ii), 74 and 76 of the Customs Act for the purpose of determining eligibility for refunds of duties and/or taxes and to facilitate refund payments to Canadian and/or Foreign casual importers. The information may be disclosed internally for the purposes of Evaluation. The information may also be disclosed externally to Public Works & Government Services Canada (PWGSC) and Canada Revenue Agency (CRA) for the purposes of issuing refunds and/or to collect outstanding monies owed.

Failure to provide the information requested on this form may result in the rejection of your request. Individuals have the right of access to and/or can make corrections of their personal information under the Privacy Act - Section 12. The information collected is described within Info Source under the Casual Refund Program Personal Information Bank CBSA PPU 1201 which is detailed at http://www.cbsa-asfc.gc.ca/.

Instructions

Part A — Importer Information

Field 1: Print your full name and address.

Field 2: Provide your telephone number(s) in order that the CBSA may contact you, if necessary, for further information.

Field 3: Provide the CBSA inventory/import receipt number from the CBSA Postal Import Form or the Casual Goods Accounting Document or from a courier receipt. You must attach the original import document.

Field 4: Fill in the date of importation of the goods.

Field 5: Provide a description of the goods in question.

Field 6: Check the reason for requesting the refund/adjustment:

1. If the goods were exported, attach proof of export (i.e. credit note from the vendor and bill of lading).
2. If the value was incorrectly assessed, indicate the proper value and attach invoices from the vendor that show the correct value.
3. For goods incorrectly described or classified, indicate the proper description of the goods and attach any descriptive literature of the goods. If known, indicate the proper classification number.
4. If you are requesting a refund for another reason, please specify the reason (i.e. goods short-shipped, goods damaged prior to release from CBSA) and attach the invoices or other documents to support your claim.

Field 7: Provide a brief explanation of your request.

Field 8: Please sign and date the request form.

Mail this request to the CBSA Casual Refund Centre (addresses below) that coincides with the first letter of your postal code.

A-B-C-E
CBSA Casual Refund Centre
P.O. Box 430
YARMOUTH NS B5A 4B3

G-H-J-K
CBSA Casual Refund Centre
555 McArthur Street
P.O. Box 1454
Ville St-Laurent, QC H4T 1T4

L-M-N
CBSA Casual Refund Centre
7th floor - Suite 718, 55 Town Centre Court
SCARBOROUGH ON M1P 4X4

P-R-S-T-X
CBSA Casual Refund Centre
Unit 14 Terminal 2, 101-2019 Sargent Ave.
WINNIPEG MB R3H 0Z7

V-Y
CBSA Casual Refund Centre
300 - 5940 Ferguson Road
RICHMOND BC V7B 0B4

Date modified:

2020-02-05