BSF905: Marine export reporting application form
Electronic data interchange (EDI)

The information you provide in this document is collected under the authority of the Customs Act section 95 for the purpose of administering the Canada Border Services Agency (CBSA) Export Program. The information may be used or disclosed for the following purposes: Enforcement, Safety, Security and Statistics and may be shared with Statistics Canada, Global Affairs Canada (GAC), Canadian Security Intelligence Service (CSIS), Royal Canadian Mounted Police (RCMP), Canadian Food Inspection Agency (CFIA). The Business Identification Number may be shared internally with the Operations Branch (Border Services Officers, Intelligence, Counter Proliferation); in order to provide risk assessment checks; issue Administrative Monetary Penalties (AMPs). You have the right to access and to make corrections to your personal information under the Privacy Act, Section 12. The information collected is described within “Information about Programs and Information Holdings 2018” under the Personal Information Bank Export Program CBSA PPU 1103 and Personal Information Bank Administrative Monetary Penalty System Program CBSA PPU 001 which are detailed within the Information about Programs and Information Holdings 2018. Should you have concerns about the CBSA's handling of your personal information you have a right to file a complaint with the Privacy Commissioner of Canada.

Section 1 – Company information

Are you a Customs Self-Assessment (CSA) Carrier?
Yes
No

Will you be transmitting cargo reports for CSA goods?
Yes
No

Date of application
Name of applicant (company)
CBSA Issued Carrier Code
Address of company's head office:
City, Province
State, Country
Postal/Zip code
Contact person
Title
Telephone number
e-mail
Afterhours Contact person
Title
Afterhours Telephone number
Afterhours e-mail
In which language would you like to be assisted?
English
French

Canadian Business Office (if different from Head Office):

Name of company
Address
City
Province
Postal code
Contact person
Title
Telephone number
e-mail

Section 2 – Communication method information

For more information on the approved communication methods, please consult the following link: www.cbsa-asfc.gc.ca/eservices/comm-eng.html.

If your company is using a service provider to exchange data with the CBSA, please complete this block. Note that you will need to contact your service provider to obtain the required information below.

Name of service provider

Customs Internet Gateway

Production Certificate Number
Testing Certificate Number
Mailbox ID: (Partner ID from the ISA or UNB segment)
Sender ID: (Client defined application send ID, per the GS or UNB segment)

Direct Connect / VAN

Name of Direct Connect
Mailbox ID: (Partner ID from the ISA or UNB segment)
Sender ID: (Client defined application send ID, per the GS or UNB segment)
If your company will be exchanging data directly with the CBSA, please complete this block

Method of communication

Customs Internet Gateway
Direct connect
Name:
Value Added Network
Name:
Mailbox ID: (Partner ID from the ISA or UNB segment)
Sender ID: (Client defined application send ID, per the GS or UNB segment)

Section 3 – Agent information

Complete this section if you have contracted the services of an Agent to act on your behalf. Please note that the obligation to provide information required by the Customs Act and any related regulation to the CBSA is the sole responsibility of the client regardless of whether an agent is used. It is your responsibility to advise the CBSA should/when you wish to cancel authorization for this agent.

Name of Agent's (company name)
Address
City
Province
Postal code
Contact person
Title
Telephone number
e-mail
Requested implementation date

Section 4 – Certification

This form must be signed by an authorized person of the business such as an owner, a partner of a partnership, or a director of a corporation. By signing and dating this form, you authorize the CBSA to deal with the individual(s), or firm(s) listed in Sections 2 and/or 3 of this form.

Language
English
French
Email
Telephone
Authorized Person's Name
Title
Signature
Date (yyyy-mm-dd)

Completed forms can be sent to:

Manager, Technical Commercial Client Unit Program Business System Integration
Canada Border Services Agency
355 North River Road, 6th Floor, Tower B
Ottawa, Ontario, Canada K1A 0L8
by email: tccu-ustcc@cbsa-asfc.gc.ca

Date modified:

2021-12-21