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Canada Border Services Agency
PROTECTED A
Duty Free Shop Address Name of contact Telephone No. Fax No.
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Sales for the month of
Agence des services frontaliers du Canada
DUTY FREE SHOP SUMMARY OF MONTHLY SALES
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The information collected on this form is held in CBSA Bank "Duty Free Shop Monthly Sales". DFS No. CBSA Office No. CBSA Authorization No. CBSA Initial CBSA Telephone No. I hereby certify that the information in this return is correct and complete. Name Title Signature Date Received at CBSA: (Date Stamp)
Gross sales this period Categories Domestic $ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Accessories (purses, wallets, sunglasses, belts, lighters) Alcohol (liquor, liqueur, wine, coolers) Beer (beer, malt-based coolers) Clothing (including hats, fur, leather) Crafts/arts Electronics, cameras, binoculars, telescopes, televisions Food Glassware, crystal, china, figurines, porcelain Jewellery, watches, clocks Office and travel supplies (suitcases, calculators, key holders, all types of bags, pens, luggage) Perfume, cosmetic, skincare products Souvenirs (no clothing) Tobacco, cigars, loose tobacco Other (pet supplies) Imported Duty and Tax Paid $ Imported Duty and Tax Not Paid $ Total $ Domestic $
Gross sales year-to-date Imported Duty and Tax Paid $ Imported Duty and Tax Not Paid $ Total $
Totals Domestic Tobacco Sales Cigarettes Cartons Tobacco Tins Sticks Cartons Cigars Total Domestic Tobacco Sales Imported Tobacco Sales Cigarettes Cartons Tobacco Tins Sticks Cartons Cigars Total Imported Tobacco Sales B117 E BSF179 E Total Sales $ Units Special Duty (DFS) Net Sales $ Total Sales $ Units Special Duty (DFS) Net Sales $ Total Sales $ Units Special Duty (Mfr) Net Sales $ Total Sales $ Units Special Duty (Mfr) Net Sales $
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