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Import Permit Extension Application Form

TIEZA extension application form for import permit

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Form No. IA.1.F.005
Received by: _________________
Date : _________ Time : _______

Application No. ______________
Official Acceptance (Stamp Below)

TOURISM INFRATRUCTURE AND ENTERPRISE ZONE AUTHORITY
REQUEST FOR IMPORT PERMIT EXTENSION
1. Applicant
Name:
Office Address:
Representative:
Designation/Registration No.
Registered Activity:
Zone Location:
Type of Zone

TIN No.
Tel No.
Date Registered:

Type of RTE:

Fax No.

[ ] New
[ ] Expanding
[ ] Outside a TEZ

2. Issued Import Permit
Import Permit No:

Valid From:
Valid Until:

Shipper Name:
Country of Origin:
Post of Discharge:
Pro-forma Invoice:

Estimated Departure Date:
Estimated Arrival Date:
Total Value:

3. Importation balance / Summary Sheet
Item
No.

AHTN Description
Code

Unit

Total Quantity (Gross Weight)

Total

FOB Value US$
Used Remaining Total
Used Remaining

4. Applicable for extension with partial delivery and remaining balance
Item
No.

Shipped
Item

Bill of Lading Number

Packing List Commercial
Number
Invoice Number

Delivered
Delivered
Quantity (gross Amount
weight)
(FOB Value
US$)

Certified True and Correct:
____________________________________
Contractor
(Signature Over Printed Name & Designation)

____________________________________
Owner
(Signature Over Printed Name & Designation)
 
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