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Registration Form No. Date

Importer Name

ِ Authorized Manager

Address

Contact information

Tel.

Fax.

E.Mail

Website

Type of Activity .

Exemption Status

Exempt

Not Exempt

Bank Name

Account No.

L\c amount

L\c No.

Agent Name

Agency ID.

Issuance Date

Pledge

The Information given on this application is true and correct to the best of my knowledge and belief.

I also understand that I am obligated to notify the Customs Commission immediately of any changes in conditions that may affect my exemption status.

I also understand that false statements made on this form may subject me to penalties under the Customs law No. or administrative penalties under the regulation

Signature:

Full Name :

Custom Directorate

Custom affairs

ID No.

Registration Form No.

Date

Date

Importer Name

Authorized Manager

Address

Agent Name

Agent ID.

Issuance Date

Exemption Status

Manager of Custom Inspection Department