All travellers must be identified on a Canada Border Services Agency (CBSA) Declaration Card. You may list up to four people living at the same address on one card. Each traveller is responsible for his or her own declaration. Each traveller is responsible for reporting currency and/or monetary instruments totaling CAN$10,000 or more that are in his or her actual possession or baggage.

Under the law, failure to properly declare goods, currency and/or monetary instruments brought into Canada may result in seizure action, monetary penalties and/or criminal prosecution.

Part A  All travellers (living at the same address)

Please print in capital letters. 

1. Last      name, first name and initials 
        Date of birth: YY - MM - DD 
        Citizenship:

2. Last      name, first name and initials 
        Date of birth: YY - MM - DD 
        Citizenship:

3. Last      name, first name and initials 
        Date of birth: YY - MM - DD 
        Citizenship:

4. Last      name, first name and initials 
        Date of birth: YY - MM - DD 
        Citizenship: 

Home address

• Number,      street, apartment No.

• City/Town

• Prov./State

• Country

• Postal/Zip      code

Arriving by:

• Air

• Rail

• Marine

• Highway

Airline/Flight No., train No. or vessel name

Purpose of trip:

• Study

• Personal

• Business

Arriving from:

• U.S.      only

• Other      country direct

• Other      country via U.S.

I am/we are bringing into Canada:

• Firearms      or other weapons (e.g. switchblades, Mace or pepper spray). (Yes/No)

• Commercial      goods, whether or not for resale(e.g. samples, tools, equipment). (Yes/No)

• Meat/meat      products; dairy products; fruits;vegetables; seeds; nuts; plants and      animals or theirparts/products; cut flowers; soil; wood/woodproducts;      birds; insects. (Yes/No)

• Currency      and/or monetary instruments totalingCAN$10,000 or more. (Yes/No)

I/we have visited a farm and will be going to a farm inCanada. (Yes/No)

I/we have unaccompanied goods. (Yes/No)

Part B - Visitors to Canada

• Duration      of stay in Canada (days)

• Do      you or any person listed above exceed the duty-freeallowances per person?      (See instructions) (Yes/No)

Part C - Residents of Canada

• Do      you or any person listed above exceed the duty-freeallowances per person?      (See instructions) (Yes/No)

Complete in the same order as Part A 

1. Date      left Canada YY - MM - DD  
        Value of goods – CAN$ purchased or received abroad (including gifts,      alcohol & tobacco) 

2. Date      left Canada YY - MM - DD  
        Value of goods – CAN$ purchased or received abroad (including gifts,      alcohol & tobacco) 

3. Date      left Canada YY - MM - DD  
        Value of goods – CAN$ purchased or received abroad (including gifts,      alcohol & tobacco) 

4. Date      left Canada YY - MM - DD  
        Value of goods – CAN$ purchased or received abroad (including gifts,      alcohol & tobacco) 

Part D  Signatures (age 16 and older):

I certify that my declaration is true and complete. 

1. Signature
        YY - MM - DD 

2. Signature
        YY - MM - DD 

3. Signature
        YY - MM - DD 

4. Signature
        YY - MM - DD