Form completed by:
E-Mail Address:
Company
Information
Name
of Company:
Type
of Business:
Head
Office
Address
1:
Address 2:
City:
Province:
Newfoundland
Nova Scotia
Prince Edward
Island
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
Yukon
Nunavut
Northwest
Territories
Postal
Code:
Telephone:
Fax:
Toll Free:
Website Address:
Email Address:
Head
Office Principal Contacts
Principal:
Title:
Phone
Number:
Fax
Number:
E-mail:
Principal:
Title:
Phone
Number:
Fax
Number:
E-mail:
Principal:
Title:
Phone
Number:
Fax
Number:
E-mail
Head
Office's Key Contacts
Not
Applicable:
Person
with overall responsibility for Air Cargo Security:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
with overall responsibility for Airfreight:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
with overall responsibility for Oceanfreight:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
responsible for Road transportation:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
with overall responsibility for Rail transportation:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
with overall responsibility for HR/Training:
Title:
Phone
Number:
Fax
Number:
E-mail:
Not
Applicable:
Person
with overall responsibility for technical Dangerous
Goods issues:
Title:
Phone
Number:
Fax
Number:
E-mail:
Branch
Offices
No. Of Branch Offices
Please
click here to enter branch office information (New window will pop up)
Office
Information
No. of employees:
under 5
5-15
15-30
30-45
45-60
60 upwards
No. of offices in
Canada:
General
Company Information
What
service(s) is your company mainly involved in? (select
as many as applicable)
Air
transportation
Ocean
transportation
Rail
transportation
Road
transportation
Customs
Logistics
Warehousing
Distribution
Projects
Other
Is
your company an IATA Cargo Agent?
YES
Is
your company an Individual Member of CSCB?
YES
Is
your company an Individual Member of AICBA?
YES
*** Membership in CIFFA, includes
membership in FIATA ***
What
area(s) in the world does your company specialize in?
(select as many as applicable)
North
America
Central
America
South
America
Caribbean
Europe
Middle
East
Africa
Central
Asia
Eastern
Asia
South-Eastern
Asia
South
Pacific
Australia
President:
Vice-President:
Secretary:
Treasurer:
Errors
and Omissions Insurance
Information
about the applicant company (to determine Class of Membership according to the By-Laws)
Errors
and Omissions Insurance in place (min. CAD $250,000.00)
YES
Policy
Expiry Date:
Person
with overall responsibility for Errors and Omissions
Insurance:
Title:
Phone
Number:
Fax
Number:
E-mail:
Incorporation
Date
Federal:
Provincial:
Share
Structure
If other
than individual, then shareholders, officers and/or
directors of the corporation must be shown along with
percentage owned of said corporation.
Shareholder
% owned
Has the
Applicant or any person who is financially associated
with the Applicant been found guilty of willful
violation of any fiduciary obligation to the public?
If yes,
please give details:
Officers
for the Company
Official sending in
the application:
Title of Official:
Each firm
may name two representatives, a designated and an
alternate representative. Representatives can only be
changed by a member firm with the approval of the
Association.
Designated Firm
Representative:
Alternate
Representative:
Proposed By:
Email address:
CIFFA Member Seconded
By:
Email address:
CIFFA
Member
Please
note that the application for
membership must be supported by two current CIFFA
members of good standing. The companies names appearing
above will be contacted to confirm their support of your
application. This application will not be processed or
accepted before this confirmation. If the supporting
company's e-mail address has been supplied, a copy of
this application will be sent to them.
Please
check off the appropriate CIFFA region where the head office is located:
Questions regarding membership should be addressed to the Secretariat's Membership Coordinator at email membership@ciffa.com
Application
is incomplete until receipt of payment. Make cheque
payable to CIFFA National or payment by the following credit cards:
Visa No.:__________________________________________ Expiry Date:__________________
Mastercard No.:_____________________________________ Expiry Date:__________________
Name of card holder:______________________________________
CIFFA
Regular Membership Fees -- Effective May 17,
2006
Fee*
One or more
forwarding offices in one Province in Canada
$950.00
One
or more forwarding offices in two provinces in
Canada
$1295.00
One or more
forwarding offices in three provinces in
Canada
$1695.00
One
or more forwarding offices in four or more
provinces in Canada
$1995.00
*Subject to applicable tax(es) CIFFA GST#122975439
SUBSIDIARY COMPANIES: A
subsidiary company is defined as a company where the
regular C.I.F.F.A. member has a controlling interest of over 50% ownership.
Subsidiary Offices of Regular Members - Fee Structure Fee*
Head Office Location
$295.00
Additional Branch Offices (each)
$65.00
Applicant
Firm:
Signature
of Official:
Date:
Please make you r cheque payable to CIFFA, and mail together with accompanying
documentation to CIFFA, 480 - 170 Attwell Drive, Toronto, Ontario M9W 5Z5
______________________________________________________________________________________________
For Official Use Only:
Credit Card Authorization No.:____________________________________
Date Processed:_____________________________
