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New Zealand Gazette – 2004 – No. 138

Page 3413

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✨ Customs Clearance Form

28 OCTOBER 2004
NEW ZEALAND GAZETTE, No. 138
3413

Rule 4(a)

Form C3

CERTIFICATE OF CLEARANCE
(SHIPS AND BOATS OTHER THAN SMALL CRAFT)

Te Mana Arai o Aotearoa

PART A: DEPARTURE DETAILS

Name of ship	Port of departure
Date of departure	Time of departure
Name of person in charge
IMO number
Gross register tonnes
Segregated ballast tanks total tonnage (Tankers only)

LIST PORTS VISITED WHILE IN NEW ZEALAND ON THIS VOYAGE (Please record on a separate sheet and attach if additional space is required.)

New Zealand ports visited	Date of arrival	Date of departure
1.
2.
3.
4.
5.

LIST OVERSEAS PORTS EN ROUTE TO PORT OF DESTINATION (Please record on a separate sheet and attach if additional space is required.)

1.
2.
3.

Total number of crew on departure	Total number of crew embarked in New Zealand	Total number of passengers on departure	Total number of passengers embarked in New Zealand

This is to certify that ……………………………………………………………………………………
being the person in charge of the above named craft has complied with the provisions of Section 34 of the Customs and Excise Act 1996, and is hereby granted this Certificate of Clearance from New Zealand.

……………………………………………………………
Signature of Customs officer

Stamp

NOTES

You are required to depart immediately for your next overseas port as specified in this certificate. You are not to go to any other place in New Zealand. Every person who commits an offence against this requirement is liable on conviction to imprisonment for a term not exceeding 12 months or to a fine not exceeding $15,000.
In an emergency you must contact the New Zealand Customs Service on Freephone: 0800 654279 or via a coast radio station on VHF ch16, 2182khz, 4125khz, 6215khz, or 8291khz.

VUW Te Waharoa — NZ Gazette 2004, No 138

Gazette.govt.nz — NZ Gazette 2004, No 138

Parliament House (depicted) was completed in 1918 and remains the primary seat of Parliament.

✨ LLM interpretation of page content

🏭 Certificate of Clearance Form for Ships and Boats (continued from previous page)

Domain🏭 Trade, Customs & Industry
KeywordsCustoms, Certificate of Clearance, Ships, Boats, Departure, Form C3

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