I affirm that the information given above is true and correct. I undertake to pay customs duty and GST on the liquors, tobacco and motor vehicle included in my consignment, and also not to dispose of used household articles and personal effects within three months from the date of importation.
SIGNATURE:_________________________________________________________
NAME OF CLAIMANT:__________________________________________________
PASSPORT NO.:______________________________________________________
DATE: _____________________________________________________________
OCCUPATION: ______________________________________________________
NAME OF EMPLOYER: _________________________________________________
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