Registration Form No. Date

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 Importer Registration Application Importer Registration ID