Form Fin 363 - Application For Carriet Licence International Fuel Tax Agreement (Ifta)
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1
2APPLICATION FOR
Ministry of
Mailing Address:
Provincial Revenue
PO Box 9442 Stn Prov Govt
CARRIER LICENCE
Consumer Taxation Branch
Victoria BC V8W 9V4
INTERNATIONAL FUEL TAX
AGREEMENT (IFTA)
Pursuant to the Motor Fuel Tax Act
Information: Call the Consumer Taxation Branch in
Victoria:
250 387-0635
Vancouver:
604 660-4524
Rest of the Province:
1 877 388-4440
Freedom of Information and Protection of Privacy Act (FIPPA)
The personal information requested is collected under the
authority of and used for the purpose of administering the Motor
Fuel Tax Act . Questions about how the FIPPA applies to this
personal information can be directed to the general inquiry line
at 604 660-4524 in Vancouver, or toll-free at 1 877 388-4440
elsewhere in Canada, or in writing to Revenue Programs Division,
Suite 800 - 360 West Georgia Street, Vancouver BC V6B 6B2.
Note: Please mail the completed application form
and any applicable fees to the address above.
Please type or print clearly
TAX ACCOUNT NO.
1
– legal name of business organization, proprietor or partners
NAME OF APPLICANT
FEDERAL BUSINESS NO.
US DEPARTMENT OF TRANSPORT NO. (USDOT)
2
– If applicable
TRADE NAME/DOING BUSINESS AS
3
NAME OF CONTACT PERSON FOR IFTA PURPOSES
4
– Must be a physical location, P.O. Box No. is not acceptable
CITY
CARRIER'S BUSINESS ADDRESS
– If applicable
PROVINCE/STATE/COUNTRY
POSTAL/ZIP CODE
TELEPHONE NO.
FAX NO. – If applicable
EMAIL ADDRESS
(
)
(
)
5
– If different than business address above
MAILING ADDRESS
CITY
PROVINCE/STATE/COUNTRY
POSTAL/ZIP CODE
6
– If different than business address above
CITY
LOCATION OF RECORDS
– If applicable
PROVINCE/STATE/COUNTRY
POSTAL/ZIP CODE
TELEPHONE NO.
FAX NO. – If applicable
EMAIL ADDRESS
(
)
(
)
7
TYPE OF OWNERSHIP
SOLE PROPRIETOR
PARTNERSHIP
Number:
OTHER –
Specify:
CORPORATION –
8
INCORPORATION
BUSINESS
DATE COMMENCED
YYYY / MM / DD
YYYY / MM / DD
YYYY / MM / DD
COMMENCED
TRAVEL OUTSIDE OF
DATE
DATE
HOME JURISDICTION
9
DO YOU HAVE AN ACTIVE IFTA LICENCE WITH ANOTHER JURISDICTION?
JURISDICTION
IFTA LICENCE NO.
If yes,
YES
NO
provide:
10
LICENCING INFORMATION
SOCIAL SERVICE TAX NO.
IRP PRORATE NO.
11
DID YOU PURCHASE THE BUSINESS FROM A PREVIOUS OWNER?
PREVIOUS OWNER'S MOTOR
PREVIOUS OWNER'S
If YES,
YES
FUEL USER PERMIT NO.
IFTA LICENCE NO.
provide:
PREVIOUS OWNER'S NAME AND ADDRESS
NO
FIN 363 Rev. 2004 / 10 / 8
Please continue on page 2
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