β¨ Customs Clearance Certificate
3542
NEW ZEALAND GAZETTE, No. 142
2 NOVEMBER 2004
SCHEDULE
Rule 4(a) Form C3

CERTIFICATE OF CLEARANCE
(SHIPS AND BOATS OTHER THAN SMALL CRAFT)
To Mana Ara Ao Taonga
PART A: DEPARTURE DETAILS
| Name of ship | Port of departure |
|---|---|
| Date of departure | Time of departure |
| Name of person in charge | Port of destination |
| IMO number | Name and address of ship's agent in New Zealand |
| 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.
Next Page →
Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2004, No 142
Gazette.govt.nz —
NZ Gazette 2004, No 142
β¨ LLM interpretation of page content
π
Customs (Certificates of Clearance) Rules 2004
(continued from previous page)
π Trade, Customs & Industry25 October 2004
Customs, Certificates of Clearance, Rules, Forms, Comptroller, Regulations