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.

PDF (139 Kb) [help with PDF files]

Canadian Head Office

Contact Person

Mode/Type of Export (please select all that apply)


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.


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.

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