Front
1. Valid until
Day
Month
Year
2. Number
3. Holder of the procedure (surname and forename, or name of company, full address and country)
4. The customs office of guarantee (reference number)
5. Reference amount
Currency code
In figures:
In letters:
6. The customs office of guarantee certifies that the holder of the procedure named above has been granted a guarantee waiver in respect of his Union/common transit operations through the customs territories listed below whose names have not been crossed out:
European Union — Iceland — former Yugoslav Republic of Macedonia — Norway — Serbia — Switzerland — Turkey — Andorra (*) — San Marino (*)
7. Special observations
8. Period of validity extended until
dd/mm/yy inclusive
Done
at on
(place) (date)
(Signature and stamp of the customs office of guarantee)
Done
at on
(place) (date)
(Signature and stamp of the customs office of guarantee)
(*) Only for the Union transit operations.
Back
9. Persons authorised to sign Union/common transit declarations on behalf of the holder of the procedure
10. Surname, forename and specimen signa-ture of authorised person
11. Signature of the holder of the procedure (*)
10. Surname, forename and specimen signa-ture of authorised person
11. Signature of the holder of the procedure (*)
(*) Where the holder of the procedure is a legal person, the person whose signature appears in box 11 must add to his signature his surname, forename and the capacity in which he is signing.
