Form L63 E "Licence and Registration Application Excise Act, 2001" - Canada

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Clear Data
Protected B
Licence and Registration Application Excise Act, 2001
when completed
This application form is for use by all spirits, wine and tobacco manufacturers, users, warehousing and registration applicants. Use this form if you are the head office of a new
or renewing applicant for an excise duty licence or registration number. Instructions for completion and links to technical memoranda and regulations are available on the back of
the application.
Section A – Type of application
Language of
Business number required?
1
New application
Amendment
Renewal
English
French
No
Yes
communication
Section B – Identification of business
(For a corporation, enter the name and address of the head office.)
Legal name
Operating / trading / partnership name
Excise duty account number
R D
Business address (This must be a physical address, not a post office box.)
Postal code
City
Province
Postal code
Mailing address (If different from business address.)
Section C – Client ownership type
Fiscal year end
All corporations must provide a copy of the certificate of incorporation or amalgamation.
Sole proprietorship
MM
DD
Partnership
(individual)
Other
Specify
Are you incorporated?
Yes
No
Section D – Information relating to individuals, partners, directors or officers
Complete this part to provide information about the individual, partner(s), corporate director(s), or officer(s) of your business. (If you need more space, include the information on a
separate sheet. )
First name
Last name
Work telephone number
Date of birth (YYYY–MM–DD)
Position or title
Work fax number
Business address
Postal code
Mailing address
Postal code
Section E – Additional premises
If more than one premises, please complete the area below. (If you need more space, include the information on a separate piece of paper.)
Name of premises
Business address
Mailing address
Licence or registration type
Telephone number
Fax number
Section F – Licences and registrations
Indicate type of
Special excise
Spirits
Wine
User
Tobacco
Tobacco dealer
Excise warehouse
Duty-free shop
licence(s) required
warehouse
Indicate type of
Ferment-on-premises
User
Alcohol
Specially denatured alcohol
registration required
Section G – Security
(for spirits licences or tobacco licences only)
Enter the type and the amount of security provided
Transferable non-certified
Type of security
Cash
Certified cheque
Surety bond
Other
Government of Canada Bond
Bond/Surety company name
Bond number (if applicable)
Amount of security
Section H – Financial institution(s)
(Licence applicants must complete this section)
Enter the name and address of the branch(es) of the financial institutions(s) used by the applicant. If needed, use a separate piece of paper.
Name
Address
Branch number
Institution number
Account number
Section I – Contact person
Complete this area to identify an employee of your business as your contact person in all matters pertaining to your excise duty accounts. To authorize a representative who is not an
employee of your business, complete form RC59, Business Consent Form.
First name
Last name
Position or title
Telephone number
Fax number
E-mail address
Section J – Certification
, certify that the information given on this form and any document attached is, to the best of
As an authorized person I,
Name
my knowlege, correct and complete.
Position or title
Date (YYYY–MM–DD)
Signature of authorized person
See the privacy notice on the next page.
L63 E (19)
(Ce formulaire est disponible en français.)
Clear Data
Protected B
Licence and Registration Application Excise Act, 2001
when completed
This application form is for use by all spirits, wine and tobacco manufacturers, users, warehousing and registration applicants. Use this form if you are the head office of a new
or renewing applicant for an excise duty licence or registration number. Instructions for completion and links to technical memoranda and regulations are available on the back of
the application.
Section A – Type of application
Language of
Business number required?
1
New application
Amendment
Renewal
English
French
No
Yes
communication
Section B – Identification of business
(For a corporation, enter the name and address of the head office.)
Legal name
Operating / trading / partnership name
Excise duty account number
R D
Business address (This must be a physical address, not a post office box.)
Postal code
City
Province
Postal code
Mailing address (If different from business address.)
Section C – Client ownership type
Fiscal year end
All corporations must provide a copy of the certificate of incorporation or amalgamation.
Sole proprietorship
MM
DD
Partnership
(individual)
Other
Specify
Are you incorporated?
Yes
No
Section D – Information relating to individuals, partners, directors or officers
Complete this part to provide information about the individual, partner(s), corporate director(s), or officer(s) of your business. (If you need more space, include the information on a
separate sheet. )
First name
Last name
Work telephone number
Date of birth (YYYY–MM–DD)
Position or title
Work fax number
Business address
Postal code
Mailing address
Postal code
Section E – Additional premises
If more than one premises, please complete the area below. (If you need more space, include the information on a separate piece of paper.)
Name of premises
Business address
Mailing address
Licence or registration type
Telephone number
Fax number
Section F – Licences and registrations
Indicate type of
Special excise
Spirits
Wine
User
Tobacco
Tobacco dealer
Excise warehouse
Duty-free shop
licence(s) required
warehouse
Indicate type of
Ferment-on-premises
User
Alcohol
Specially denatured alcohol
registration required
Section G – Security
(for spirits licences or tobacco licences only)
Enter the type and the amount of security provided
Transferable non-certified
Type of security
Cash
Certified cheque
Surety bond
Other
Government of Canada Bond
Bond/Surety company name
Bond number (if applicable)
Amount of security
Section H – Financial institution(s)
(Licence applicants must complete this section)
Enter the name and address of the branch(es) of the financial institutions(s) used by the applicant. If needed, use a separate piece of paper.
Name
Address
Branch number
Institution number
Account number
Section I – Contact person
Complete this area to identify an employee of your business as your contact person in all matters pertaining to your excise duty accounts. To authorize a representative who is not an
employee of your business, complete form RC59, Business Consent Form.
First name
Last name
Position or title
Telephone number
Fax number
E-mail address
Section J – Certification
, certify that the information given on this form and any document attached is, to the best of
As an authorized person I,
Name
my knowlege, correct and complete.
Position or title
Date (YYYY–MM–DD)
Signature of authorized person
See the privacy notice on the next page.
L63 E (19)
(Ce formulaire est disponible en français.)
Clear Data
Privacy Notice
Personal information is collected under the Excise Act, 2001 and its Regulations for the purpose of administering licences and registrations. All information provided is subject to
verification and may include criminal record and financial checks. Information may be shared or verified with other federal, provincial / territorial government institutions to the extent
authorized by law. Failure to provide this information may result in administrative delays or a refusal to issue licences or registrations. Personal information is described in CRA PPU 062
and is protected under the Privacy Act. Individuals have a right of protection, access to and correction or notation of their personal information. Please be advised that you are entitled to
complain to the Privacy Commissioner of Canada regarding our handling of your information.
Instructions for completion
Section A – Type of application
Check the box that best describes this application if it is a new, amended or renewed application. You may also indicate the language of choice,
and whether you require a 9-digit business number (BN).
Section B – Identification of business
Enter the legal name, operating/trading or partnership name and the excise duty account number of the business. The legal name (if applicable)
is the name of the business that appears on all official documents or legal papers. The trading name is the name that the business client trades
under or the name by which suppliers or customers know the business. Enter the physical location and mailing address of the business including
the postal code for both.
Section C – Client ownership type
Check the box that best describes your business type. If the business is a partnership, you must provide a partnership agreement. If it is a
corporation, you must provide us with a copy of the certificate of incorporation or amalgamation.
Section D – Individuals, partners and officers of the company
Enter the full name, business and mailing address, title, telephone number, date of birth and social insurance number of each proprietor, partner or
director. If there is insufficient space, use a separate sheet and attach it to this form.
Section E – Additional premises
If you operate out of more than one business location (premises), please list the name, business and mailing addresses, licence or registration
type that is applicable for each premises, telephone and fax numbers. Please use and attach to this L63 form, a separate sheet to list all premises
and related type of licence or registration. Separate premises have the option of filing separate excise duty returns. If you wish to have one or more of
your premises file a separate return, please indicate this on the list of additional premises. Additional information on filing separate returns is available
in Excise Duty Memorandum EDM10.1.1,
Returns and Payments.
Section F – Licences and registrations
Licence type required: check the box beside the type of licence(s) required. Licensing applicants should refer to Excise Duty Memoranda EDM2.1.1,
Licence
Types, EDM2.2.1,
Obtaining and Renewing a Licence
and the
Regulations Respecting Excise Licences and
Registrations.
Spirits – Applicants for a spirits licence should refer to Excise Duty Memorandum EDM3.1.1,
Producers and Packagers of
Spirits.
Wine – Applicants for a wine licence should refer to Excise Duty Memoranda EDM4.1.1,
Producers and Packagers of Wine
and
EDM4.1.2,
Small Producers of
Wine.
User – Applicants for a users licence should refer to Excise Duty Memorandum EDM3.1.2,
Licensed
Users.
Tobacco – Applicants for a tobacco licence should refer to Excise Duty Memoranda EDM7.1.1,
Manufacturers of Tobacco
Products.
Tobacco Dealer – Applicants for a tobacco dealers licence should refer to Excise Duty Memorandum EDM7.1.2,
Tobacco
Dealers.
Excise Warehouse – Applicants for an excise warehouse licence should refer to Excise Duty Memorandum EDM8.1.1,
Excise
Warehouses.
Special Excise Warehouse – Applicants for a special excise warehouse licence should refer to Excise Duty Memorandum EDM8.1.2,
Special Excise
Warehouses.
Duty-Free Shop – Applicants for a duty-free shop licence should refer to Excise Duty Memoranda EDM7.1.4,
Duty Free Shop
Operators.
Registration type required: check the box beside the type of registration(s) required. Registration applicants should refer to Excise Duty
Memoranda EDM2.3.1,
Registration
Types, EDM2.4.1,
Obtaining a Registration
and the
Regulations Respecting Excise Licences
and
Registrations.
Ferment-on-premises – Applicants for a ferment-on-premises registration should refer to Excise Duty Memorandum EDM4.1.3,
Ferment-On-Premises
Registrants.
User – Applicants for a user's registration should refer to Excise Duty Memorandum EDM3.1.3,
Registered
Users.
Alcohol – Applicants for an alcohol registration should refer to Excise Duty Memorandum EDM3.1.4,
Alcohol
Registrants.
Specially Denatured Alcohol – Applicants for an SDA/DA registration should refer to Excise Duty Memorandum EDM5.1.1,
Denatured Alcohol and Specially Denatured
Alcohol.
Section G – Security (for spirits licences or tobacco licences only)
The applicant must check the box that represents the type of security attached and the amount of security provided. Enter the name of the surety
company, the bond number (if applicable) and the amount of security that is required to be provided. Information concerning surety bonds is available
in Excise Duty Memoranda EDM2.2.2,
Security Requirements for Certain Licensees and for Prescribed Persons Importing Tobacco
Products,
EDM2.2.3,
Government of Canada Bonds and Surety Bonds
and EDM2.2.4,
Approved Financial Institutions and Acceptable Bonding
Companies. A sample of an
Excise Bond for Excise Act, 2001
with completion instructions is also available on the CRA Web Site.
Section H – Financial institution(s)
Enter the name and address of the branch(es) of the financial institution(s) used for business transactions. Enter your account number(s) with corresponding
branch(es) and institution number(s) for each institution(s). This information is required for purposes of subparagraph 2(2)(c)(ii) of the
Regulations Respecting
Excise Licences and
Registrations, to indicate whether you have sufficient financial resources to conduct a business in a responsible manner.
Section I – Contact person
Enter the full name, position or title, telephone number, fax number and email address of the employee of your business authorized as the contact
person with whom we may deal with respect to your RD Excise Duty account(s). To consent to the release of confidential information to a
representative who is not an employee of your business, complete and return the form RC59,
Business Consent
Form. You may obtain that form by
clicking
canada.ca/en/revenue-agency/services/forms-publications/forms/rc59.html
or by calling us at 1-800-959-2221.
Section J – Certification
We will not process this form unless it is signed and dated by an authorized person of the business. Signing this application certifies that the
information given on this form and any document attached is to best of your knowledge, correct and complete.
1
Requirement for additional information
In order to ensure compliance with the various provisions set out in sections 2 and 3 of the
Regulations Respecting Excise Licences and
Registrations, the following
additional information is required from all licence applicants in order to assess your application. Additional information should include but is not limited to a:
✓ Business industry overview;
✓ Human resources plan;
✓ Sale and marketing plan;
✓ Operating plan;
✓ Financial plan or sources of funds;
✓ Statement of personal net worth for sole proprietorships.
Where to send your application and attachments
Send your completed form and attachments to your regional excise duty office. A complete listing of those offices is available in Excise Duty Memorandum
EDM1.1.2,
Regional Excise Duty
Offices.
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Download Form L63 E "Licence and Registration Application Excise Act, 2001" - Canada

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