Attach additional pages to any part of the application, if necessary.
Incomplete applications will not be accepted.
Protected B (when completed)
Part 1 - Applicant Identification
- Client Customs Account Name (as indicated on the Notice(s) of Penalty Assessment)
- Business Number(s) (BN)
- Carrier Code(s)
- Sub-Office Work Location (or Warehouse) Code(s)
- Language of Correspondence - English / French
- Postal Code or Zip Code
- Mailing Address (if different from address above)
- Postal Code or Zip Code
- Contact Name
- Telephone Number
- Conact Title
- Fax Number
Part 2 - Identification of Penalties
List the Penalty Assessment Number of each Notice of Penalty Assessment (NPA) that you believe was/were issued as a result of the systematic problem in your internal commercial information system (CIS). It is your responsibility to advise the Canada Border Services Agency (CBSA) of any subsequent NPA(s) that you wish to add to your application.
- Penalty Assessment Number
- Example - 12345
- Contravention number
- Notice Date
- Penalty per instance / occurrence / shipment (if applicable)
- 9 × $1,000.00
- Penalty Amount
- K21 receipt No. (if applicable)
Part 3 – Identification of CIS Problem
- Describe in detail the nature of the systematic problem(s) and how it/they resulted in the non-compliance and in the issuance of the NPA(s).
- Include supporting documentation.
Part 4 – Required Corrective Measures
- The following information must be included:
- Each of the measures used to correct the systematic problem(s) in your CIS;
- A proposed date for the completion of the corrective measure(s); and
- The method by which the corrective measure(s) can be verified and proven to be effective.
- Description of corrective measure(s)
- Proposed date(s) of completion (must be within six (6) months following the date of application)
- How corrective measure(s) is/are to be tested
Part 5 – Breakdown/Estimate of Costs for Implementing the Corrective Measure(s)
- Provide details of the projected investment(s) required to correct the systematic problem(s) in your CIS.
- Substantiate all cost estimates with supporting documentation (costs cannot be funded through government assistance).
- Indicate the type of eligible cost (from the list below) for each expense.
Note: During the review of your application, the CBSA may request, at any time, that you obtain a third party attestation to demonstrate that the costs for implementing the corrective measures were expended to eliminate the non-compliance that resulted in the issuance of penalties. The focus of the third party attestation may be on any aspect of the PRA application, including the effectiveness of the corrective measures and the eligibility of investments and their associated costs.
- Details of projected investment(s)
- Identify the type of eligible cost from the list below
- Estimated costs
- Eligible costs:
- Costs associated with the purchase or implementation of a new system or upgrades to the existing CIS that will correct the identified problem.
- Costs of purchasing supplies, hardware or equipment used to repair or modify an automated system.
- Costs of purchasing software required for an automated system.
- Costs of technical assistance used to implement and test and/or verify the effectiveness of the system upgrades, including the cost of obtaining a third party attestation.
- Costs of training employees to perform activities specifically related to the implementation of the corrective measures.
- Ineligible costs:
- Ongoing costs for training employees.
- Overhead or administrative costs.
- Renovation costs.
- Salaries for hiring employees to perform day-to-day operations.
Part 6 – Certification
- I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete.
- Name (print)
- Signature of applicant
- Name (print)
The information you provide on this form, including supporting documentation, is collected under the Customs Act and is protected under the Privacy Act. The information will be used to make a determination of your application. The information will be retained in Personal Information Bank CBSA PPU 005 and is registered with Treasury Board Secretariat number 000011. For instructions on obtaining information consult InfoSource (or the InfoSource publication) which is available at public libraries, Government public reading rooms, and on the Internet at http://infosource.gc.ca
- Date modified: