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Regular Freight Forwarder's Membership Application

This firm hereby applies for Regular Membership in CIFFA, and requests that the persons listed hereafter as its representatives.

If admitted, the firm and its representatives will be governed by the present and future By-Laws of the Association and undertake to pay such fees as may be properly authorized.

Before filling out this form, please read:

Required Fields are denoted in red

Form completed by:

E-Mail Address:

Company Information

Name of Company:

Type of Business:

Head Office

Address 1:

Address 2:

City:

Province:

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

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Office Information

No. of employees:

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 NO

Is your company an Individual Member of CSCB?

YES NO

Is your company an Individual Member of AICBA?

YES NO

*** 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 NO

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?

Yes No

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:

Western Region Région De L'Ouest	Central Region Région Du Centre	Eastern Region Région De L'Est
Saskatchewan Alberta British Columbia Nunavut Northwest Territories Yukon	Manitoba Ontario (Kingston, West to the Lakehead)	Ontario (Kingston East to Quebec border) Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland
Contact Ms. AMY GUMBOC C/o Schenker of Canada Ltd. Tel. (604) 688-8511 Email: amy.gumboc@schenker.ca	Contact MS. WENDY TRUDEAU C/o Agility Logistics Co. Tel: (905) 612-7501 Email: WTrudeau@agilitylogistics.com	Contact MS. JENNIFER KENNEDY C/o Same Day - Right-O-Way Cell: (514) 633-8026 Email: jennifer.kennedy@sameday.ca

Application is incomplete until receipt of cheque. Make cheque payable to CIFFA National:

CIFFA Regular Membership Fees -- Effective May 17, 2006
	Fee	GST (5%)	Total
One or more forwarding offices in one Province in Canada	$950.00	$47.50	$997.50
One or more forwarding offices in two provinces in Canada	$1295.00	$64.75	$1359.75
One or more forwarding offices in three provinces in Canada	$1695.00	$84.75	$1779.75
One or more forwarding offices in four or more provinces in Canada	$1995.00	$99.75	$2094.75

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 Structures	Fee	5% GST	Total
Head Office Location	$295.00	$14.75	$309.75
Additional Branch Offices (each)	$65.00	$3.25	$68.25

Applicant Firm:

Signature of Official:

Date:

Please make your cheque payable to CIFFA, and mail together with accompanying documentation to CIFFA, 170 Attwell Drive, Suite 480, Toronto, Ontario M9W 5Z5

For questions regarding CIFFA's policies and procedures, please contact admin@ciffa.com. See our legal and privacy statements.
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All Rights Reserved.