K11 – Certificate of Damaged Goods

A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.

PDF (62 Kb) [help with PDF files]

The goods described herein imported from (Country from which imported direct) via (1) appear to have been damaged between the time of direct shipment to Canada and the time of release from CBSA, and we hereby request that the goods be examined and the amount of damage be ascertained.

Dated at (place) this (date) day of (month) year (year)

Officer's certificate

Having received the importer's/owner's advice of damage on the (date) day of (month) year (year) I examined the (2) on the (date) day of (month) year (year) and found that the damage consisted of (Breakage, crushing, leakage, etc).

Instructions for completion of form

Date modified: