CBSA115 – Application for Export Reporting-carrier/Service Provider
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.
- Applicant type
- Carrier
- Service provider
- Do you provide courier services?
- Yes
- No
- CBSA carrier code
Canadian Head Office
- Company name
- Street address
- Province
- City
- Postal code
- Telephone
- Ext.
Contact Person
- Canadian contact person
- Telephone
- Ext.
- Regional contact person
- Telephone
- Ext.
Mode/Type of Export (please select all that apply)
- Mode of Export
- (A) Air
- (H) Highway
- (M) Marine
- (R) Rail
- Type of Exports
- Agricultural goods ( e.g., wheat)
- Bulk shipments
- Containers
- Hazardous waste
Comments
To Be Completed by Carrier Only
List all domestic and/or international clients for which you act as an agent.
Attach additional sheet if required.
- Company name
- Country
- Modes
- A
- H
- M
- R
Certification
As an authorized person, I, (name), certify that the information given on this form and in any document attached is, to the best of my knowledge, correct and complete.
- Signature of authorized person
- Position or Office
- Date
- Date modified: