Application For Licence Under International Fuel Tax Agreement (Ifta) Form - 2015 Page 2
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Service Nova Scotia
Application for Licence Under
IFTA Unit
PO Box 755
International Fuel Tax Agreement
Halifax, Nova Scotia B3J
(IFTA)
2V4
IFTA Account No. ________________________
IRP Account No. __________________________
New Account ☐
Renewal ☐
(Attach a copy of your IRP Cab Card. Your IRP Cab
Card is the document issued by the Registry of Motor
Check Year 2017 ☐ Licences expire December 31, 2017
Vehicles for PR plated vehicles. If you do not have PR
Check Year 2018 ☐ Licences expire December 31, 2018
plates, provide a copy of the vehicle permit.
Applicant/Carrier Information (Please print)
Legal Name _________________________________
Contact _____________________________________
Of Applicant
Name
Trade Name _________________________________
Phone # _______________________ Ext # _________
Of Applicant
(If different from Legal Name)
Fax #
_____________________________________
Civic
__________________________________
Email
_____________________________________
Address
Address
(Civic Number and Street/Road/Hwy)
Mailing
__________________________________
CRA BN# ____________________________________
Address
(PO Box or RR)
Nova Scotia Registry of ________________________
City/Town
_________________ Province ________
Joint Stock Companies #
Postal Code _________________
Location of Records
_______________________________, ____________________, __________________
(Civic number and Street/Road/Hwy)
(Town/City)
( Province/State)
Ownership Type
☐- Sole Proprietor ☐- Partnership ☐- Limited Company ☐- Limited Partnership ☐- Co-operative
Type of Operation ____________________________________________________________________________________
Other Information
1. Do you wish to file a consolidated return for fleets based outside Nova Scotia? Yes ☐ No ☐
Yes ☐ No ☐ IFTA Account # _______________
2. Were you ever registered in IFTA in any other jurisdiction?
Gasoline ☐
Diesel ☐
Propane ☐
3. Please indicate fuel types for which IFTA returns will be filed.
Compressed Natural Gas ☐ Liquid Natural Gas ☐
Brokers Only (Provide Broker’s name and address)
Broker
____________________________________
Phone # _______________ Fax # _______________
Name
Mailing ____________________________________
Civic
____________________________________
Address
(PO Box or RR)
Address
(Civic Number and Street/Road/Hwy)
City/Town ________________ Province __________
City/Town ________________ Province __________
Postal Code ______________
For Office Use Only
# Decals Issued ________________ From # __________________ to # __________________
Account # _____________________ Authorized by: ________________________ Date: ________________
https://novascotia.ca/sns/access/business/tax-commission.asp
Page 2 of 3
SNS-IFTA-A-V.30.09.17
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