E571 – Late Accounting Penalties Application for Waiver, Cancellation

Please submit in duplicate and attach supporting documentation.

• Broker (if applicable)
• Releasing office code
• Importer name
• Transaction number(s)
  • Transmission date and time (For CADEX and CUSDEC transactions)
• Reason for request
• Manager's name (please print)
  • Telephone No. and Extension
  • Fax No.
  • Signature 
  • Date 
• Refund of penalties paid
  • Central payment office
  • K84 payment date
  • Mail cheque to
  • Customs stamp
• CBSA use only
  • Request granted / Request not granted / Under consideration by Headquarters
  • Refund amount
  • Comments
  • Name (please print)
  • Signature
  • Date

Date modified:

2013-03-19