17 JUNE 2014 NEW ZEALAND GAZETTE, No. 64 1733

FORM 9 MAY 2014

Client code details

If you are importing goods for your own use or exporting goods in your own name, or employed by or conducting business as a company/entity that imports or exports goods or a company/entity that is dealing in excisable goods, or reporting on craft or reporting on cargo (or carrying out more than 1 of these activities), state below the client code(s) for all the entities in whose name you wish to lodge entries or reports.

If you are employed by or conducting business as an agent/ a broker, state below the name(s) or client code(s) of the agent/broker company (or companies) in whose name you wish to lodge entries and/or reports.

Add link to Organisation/Brokerage? Yes □ No □ Organisation/Brokerage Client Code(s) ..........................................

Remove link to Organisation/Brokerage? Yes □ No □ Organisation/Brokerage Client Code(s) ..........................................

Authority to link attached: Yes □ No □

Authority to Link: For a TSW user to be linked requires the attachment of an endorsement from the organisation that the user is requested to be linked to. This should be on the organisation letterhead and be signed by a named responsible person within the company such as manager, user’s supervisor or company officer.

Notification Preferences

To receive TSW notifications for lodgements - select ONE of the following notification methods:

No Notification Preferences □ Email □ Messaging (only available for B2B) □

Add name(s) to be notified: .......................................... Email: ..........................................

If TSW notification preferences requested - select any/all of the following WCO lodgement types:

Import □ Export □ OCR □ CRE □ ICR □ ANA □ AND □ Excise □

For the lodgement type requested - select any/all of the following lodgement status:

Cancelled □ Cleared □ Directions given □ Declaration Required □ Error □ Written Off □

Criminal convictions

Note: Information on criminal convictions does not have to be provided if you meet the eligibility criteria of the Criminal Records (Clean Slate) Act 2004. Information on these criteria is available on the Ministry of Justice website.

Do you have convictions for any of the offences as specified in section 132B of the Customs & Excise Act 1996? Yes □ No □

If you answer "Yes", please list what these are:
................................................................................................

Please provide any further information you think is relevant to your conviction(s):
................................................................................................

Declaration

I, (full name): ............................................................................ of (address): .............................................................

declare that the information I have provided is true, correct and complete in every particular.

Signature of applicant: Date:

Note: Making a declaration that is erroneous in a material particular is an offence under the Customs and Excise Act 1996. Making a false declaration may be an offence under the Biosecurity Act 1993, the Food Act 1981, and the Agricultural Compounds and Veterinary Medicines Act 1997.