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.
Protected A when completed
The Canada Border Services Agency (CBSA) may authorize importers to maintain records, relating to the imported goods, in Canada, United States of America or Mexico. Keeping records at a place other than the place of a business is a privilege granted by the CBSA to an importer. In the event of non-compliance this will lead to its cancellation and may also result in the imposition of corrective/punitive measures.
The purpose of this form is to record and set out the agreement made between the importer and the CBSA concerning the availability of records relating to the imported goods for verification purposes.
Maintenance of Importer Records Program
Trade Operations Division
Canada Border Services Agency
1980 Matheson Blvd East
Mississauga ON L4W 5R7
Canada
For more information regarding the maintenance of records, please refer to Memorandum D17-1-21 and the Imported Goods Records Regulations (SOR/86-1011) at:
I/We, Legal Company Name / Operating as / Account Name
undertake that our records will be made available in Canada upon request, at a location to be determined by the Canada Border Services Agency (CBSA) and the importer, or that we will bear the full costs and expenses of one or more officers from the CBSA travelling to our facility if our records are kept outside of Canada.
Corporate Street Address
City
State / Province
Postal / Zip Code
Country
Telephone
Place of Business Street Address (if different from corporate address)
City
State / Province
Postal / Zip Code
Country
Telephone
Business Mailing Address (if different from above)
City
State / Province
Postal / Zip Code
Country
Telephone
Records – Company/Agent’s name and Street Address (if different from Business Name and/or Address)
City
State / Province
Postal / Zip Code
Country
Telephone
Records keeper contact person
Records keeper e-mail address
Records – Company/Agent’s name and Mailing Address (if different from above)
City
State / Province
Postal / Zip Code
Country
Telephone
Server – Address of the server’s location* (if at a different location than the records’ address)
City
State / Province
Postal / Zip Code
Country
Telephone
*Add the company name hosting the server if the space is rented from a third party.
Canada Revenue Agency Business Number:
RM
If applicable, provide the name of the customs brokerage presenting this form and the agent’s name and contact information.
Customs Brokerage Company Name
Agent’s Name
Business Street Address
City
State / Province
Postal / Zip Code
Country
Telephone
Email address
For Non-Resident Importers only, the following must also be provided:
I/We* have read, understood, and agree with the foregoing and will advise the CBSA of any changes to the information provided in this Agreement.