Form Fin 363 - Application For Carriet Licence International Fuel Tax Agreement (Ifta) Page 2
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212
(1) NAME OF OWNER, PARTNER OR CORPORATE OFFICER
TELEPHONE NO.
(
)
– Include street, city, province/state, country and postal/zip code
RESIDENCE ADDRESS
(2) NAME OF OWNER, PARTNER OR CORPORATE OFFICER
TELEPHONE NO.
(
)
– Include street, city, province/state, country and postal/zip code
RESIDENCE ADDRESS
(3) NAME OF OWNER, PARTNER OR CORPORATE OFFICER
TELEPHONE NO.
(
)
– Include street, city, province/state, country and postal/zip code
RESIDENCE ADDRESS
13
DO YOU MAINTAIN BULK FUEL STORAGE IN OTHER JURISDICTIONS?
DO YOU MAINTAIN BULK FUEL
STORAGE IN BRITISH COLUMBIA?
If YES,
list jurisdictions:
YES
NO
NO
YES
14
(Applies only to carriers having additional fleets outside of BC)
ARE YOU REQUESTING CONSOLIDATED FLEET FUEL REPORTING?
If YES, please send written request to BC's Commissioner as well as to the
YES
NO
commissioner(s) of the other jurisdiction(s) for which you wish to make consolidated reports.
– Check ( ✔ ) all that apply
15
INDICATE TYPE OF FUEL USE
DIESEL
GASOLINE
PROPANE
GASOHOL
NATURAL GAS
16
IFTA DECALS
Two decals (one set) are required for each qualified motor vehicle. Unless the
NUMBER OF
NUMBER OF
number requested is unusually large, the branch will issue the number of decals
QUALIFIED
SETS OF DECALS
that a carrier considers necessary for its business operations. Please indicate
MOTOR VEHICLES
REQUIRED
the number of qualified motor vehicles and the number of decals you require.
17
FEES
FEE
For new IFTA applicants, the one-time registration fee is $300. For IFTA renewals, the annual fee is $100.
$
Please remit applicable fee with this form and make cheque payable in Canadian dollars to the Minister of
Finance.
CERTIFICATION BY APPLICANT
18
The Applicant agrees:
• to comply with the reporting, payment, record keeping and licence and decal display requirements specified in the
International Fuel Tax Agreement. Failure to comply with these provisions may result in suspension or
cancellation of the Applicant's licence.
• that it is responsible for ensuring that the decals issued are properly distributed and accounted for in quarterly
reporting for audit purposes.
• that the Province of British Columbia may withhold any refunds due to the Applicant if the Applicant is delinquent
on payment of fuel taxes to any jurisdiction that is a signatory to the International Fuel Tax Agreement.
• that the information contained on this application may be shared with other British Columbia goverment agencies,
and with other governments and other agencies, insofar as that disclosure relates to the administration and
enforcement of taxation enactments or the International Fuel Tax Agreement.
• that the statements made in this application are true and complete to the best of the Applicant's knowledge.
NAME AND TITLE – PLEASE TYPE OR PRINT
SIGNATURE
DATE SIGNED
YYYY / MM / DD
(1)
(2)
(3)
FIN 363 (Reverse) Rev. 2004 / 10 / 8
Clear Form
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