STREET:  ___________________________________________________

CITY: ____________________ PROVINCE: _______________

POSTAL CODE: _________ IMPORTER NO: ______________

PHONE: ________________ FAX: _______________________

E-MAIL: ____________________________________________

VEHICLE INFORMATION

MANUFACTURER ______________________________

VEHICLE TYPE ____________ANNUAL QTY________

ADDRESS: __________________________________________

CITY, STATE, COUNTRY : _____________________________

PHONE: ___________________ FAX: _____________________


MANUFACTURER ______________________________

VEHICLE TYPE ____________ANNUAL QTY________

ADDRESS: __________________________________________

CITY, STATE, COUNTRY : _____________________________

PHONE: ___________________ FAX: _____________________

IF ADDITIONAL LISTINGS ARE REQUIRED PLEASE ADD TO A NEW SHEET

DECLARATION

• The representations herein are true and complete.
• Material changes will be reported forthwith to Transport Canada.
• The pre-clearance system is only for purchases of vehicles from the original vehicle manufacturer by commercial importers for the purpose of re-sale. This company will not use this system to circumvent proper entry into the Inspection and Certification system operated by the Registrar of Imported Vehicles for US-specification vehicles imported from, or vehicles purchased at the retail level in, the United States.

Names of the importing company principals:

(1). Company Representative: ____________________________
Title: ________________________________________________
Signature:____________________________________________

After completion, mail or fax to the attention of: 

Director, Motor Vehicle Regulation Enforcement
Road Safety and Motor Vehicle Safety Regulation
Transport Canada
330 Sparks Street, 8th floor, Tower C
Ottawa, ON K1A 0N5
Fax: 613-998-8541

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