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Форма пассажирской таможенной декларации на английском языке

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Approved by Decision of Customs Union Commission No. 287

dated June 18, 2010

Front side

PASSENGER CUSTOMS DECLARATION

Basic form

* To be completed by a person attained the age of 16 years old

*Answer chosen by the declarant to be marked in a relevant box with x

*A copy of the executed declaration which is retained by a natural person should be kept for the whole period of temporary entry/exit and be presented to customs authorities upon return

entry

exit

1. Information on person

(surname)

(name)

(patronymic)

Series No.

(country of permanent residence)

(citizenship/nationality)

(identity document)

(arrived from (country of departure to be specified)

(goes to (country of destination to be specified)

Minor children go with me

¨ ¨

Quantity

yes no

The following customs-declarable commodities and transport vehicles are transported by me or in my favor

2. Information on a method of transportation of commodities and transport vehicles:

2.1. Accompanied luggage

¨

¨

2.2. Non-accompanied luggage

¨

¨

2.3. Commodities delivered by carrier

¨

¨

yes

no

yes

no

yes

no

Number of packages

Number of packages

Number of packages

3. Information on commodities and transport vehicles:

3.1. Currency of states – members of the Customs Union, foreign currency, traveler’s checks in the amount not exceeding 10000 USD in equivalent (table to be completed as desired by natural person)

¨

¨

yes

no

Name

Amount

In figures

In words

3.2. Currency of states – members of the Customs Union, foreign currency, traveler’s checks in the amount exceeding 10000 USD in equivalent, bills, checks (bank), bearer securities

¨

¨

yes

no

3.3. Transport vehicles

¨

¨

yes

no

Reg. number

Date of manufacture

Body № or identification №

Type, brand

Engine capacity (cm3)

Chassis №

Customs value

Direction of transportation:

¨

¨

import

export

¨

¨

temporary import

re-export

Taken off state registration in the country of previous registration

¨

¨

yes

no

3.4. Commodities in respect of which any prohibitions or restrictions are applied

¨

¨

yes

no

3.5. Indivisible commodities weighing over 35 kg, commodities totally weighing over 50 kg and (or) of the total customs value over 1500 euro

¨

¨

yes

no


Back side

4. Information on commodities specified in sub-items 3.4, 3.5, customs-declarable commodities, and other commodities as desired by natural person:

№ №

Name and other distinguishing marks of commodities, number and date of issue of document which confirms that restrictions are observed, and issuing authority

Weight/quantity

Value of currency of states - members of the Customs Union, euro or USD

in figures

in words

Total weight/quantity and value (Total):

I know that specifying inaccurate information in the customs declaration involves responsibility in accordance with laws of states – members of the Customs Union

__________________ (date)

Person’s signature

For official marks:

seal


Back side

3. Information on owner of cash money and (or) cash instruments

  • o declarant
  • o other natural person
  • o another person

3.1. Information on owner of cash money and (or) cash instruments – to be specified if declarant is not owner

Surname, name for natural persons/

name of another person

Residence address for natural person/ residence address (legal address) for another persons

4. Information on origin of cash money and (or) cash instruments

  • o salary, incomes from natural person’s business
  • o dividends and other incomes from share in capital of companies
  • o incomes from sale of movable and immovable property
  • o free-of-charge transfers received from natural persons and legal entities (material aid, grants etc.)
  • o pension, scholarship, social security benefits, alimonies
  • o incomes from lease of immovable property and plots of land
  • o borrowed funds
  • o inheritance
  • o other (to be specified) ____________________

5. Information on supposed use of cash money and (or) cash instruments

  • o current expenses (acquisition of commodities and services)
  • o investments including acquisition of immovable property
  • o free-of-charge transfers in favor of natural persons (material aid etc)
  • o free-of-charge transfers in favor of legal entities (charity, donations etc)
  • o other (to be specified) ____________________

6. Information on route and method of transportation (mode of transport) of cash money and (or) cash instruments

Country of departure

Country of arrival

Date of departure

Date of arrival

Transit countries

Mode of transport by which the decranat arrived at/departs from the territory of the Customs Union

  • o

air

  • o

railway

  • o

water

  • o

motor

  • o

other

I know that specifying inaccurate information in the customs declaration involves responsibility in accordance with laws of states – members of the Customs Union

Person’s signature _____________

Declaration completed on ______________ (date)

For official marks:

seal


Front side

Enclosure to passenger customs declaration

PASSENGER CUSTOMS DECLARATION

Additional form “Declaration of cash money and (or) cash instruments”

The form is completed by natural persons attained 16-years old when transporting across the customs border of the Customs Union:

- cash money (banknotes and coins, except for coins of precious metals) and traveler’s checks in the amount exceeding 10 000 USD in equivalent;

- another cash instruments in documentary form (bills, checks (bank), bearer securities.

When completing the form, information on all transported cash money, traveler’s checks and cash instruments

Type

of declaration

  • o entry to territory of the Customs Union
  • o exit from territory of the Customs Union

1. Information on natural person

(surname)

(name)

(patronymic)

(place and date of birth (d/m/y)

(citizenship/nationality)

(country of permanent residence)

(type of identity document)

(series, No.)

(date and place of issue)

(address of permanent residence)

(address of place of stay (registration) in the territory of the Customs Union)

(number and date of issue of visa (details of document which confirms the right to stay in the territory of the Customs Union))

2. Information on cash money and cash instruments

2.1. Cash money and traveler’s checks

Amount

Kind of currency

Banknotes, coins

Traveler’s checks

2.2. Cash instruments, except for traveler’s checks (bills, checks (bank), bearer securities and other)

Type of instrument

Issued by

Date of issue

Identification number (if any)

Quantity

Value