Form A - FORM – A [See Regulation 5(1)] - Customs House Agents Licensing Regulations, 2004

FORM-A [See Regulation 5(1)] To The 1 [Principal Commissioner of Customs or Commissioner of Customs, as the case may be], (Details of jurisdiction) Subject : Application Form for Grant of Custom House Agents Licence under Section 146 of the Customs Act, 1962 Sir/Madam, In response to the Public Notice No dated I/We undersigned hereby submit the following details for Grant of Custom House Agents Licence under Section 146 of the Customs Act, 1962 : 1. Name of the applicant, (in case the applicant is a firm or a company, the names of each of the partners of the firm or the directors of the company, as the case may be):- 2. Full address of the applicant, (in case, the applicant is a firm or a company, the address of each of the partners of the firm or the directors of the company, as the case may be):- 3. In case the applicant is a firm or a company, the name(s) of its partner/partners or director/directors or duly authorized employees who will actually be engaged in the work, as Customs House Agents. 4. In case it is desired to appoint clerk(s), the name and address of the clerk(s):- 5. Educational Qualification of each of the persons, who will actually be engaged in the work as Customs House Agent (including proof of working knowledge of computers) :- 6. Particulars regarding knowledge of English, local language and Hindi (these particulars are required in respect of each of the persons actually engaged in the work as Customs House Agent). 7. Particulars regarding knowledge of Customs Law and procedure. (These Particulars are required in respect of each of the persons actually engaged in the work as Customs House Agent. 8. Whether the applicant had earlier applied for a licence to act as Customs House Agent and whether such application was rejected. 9. Whether he or the firm or company by whom he is employed have earlier held a Customs House Agent's Licence under these Regulations and whether it was cancelled or suspended. 10. Whether the applicant or any of the person proposed to be employed by him have been penalized, convicted or prosecuted under any of the provisions of the Customs Act, 1962 (52 of 1962) or any other law for the time being in force :- 11. Number and date of each of the documents furnished in accordance with Regulation 5. I/We hereby affirm that I/We have read the Customs House Agent's Licensing Regulations, 2004. and agree to abide by them. Date : Signature of applicant(s) Sd/- Aseem Kumar Under Secretary Has been substituted vide Notification No. 77/2007 Custom (NT) dated 27/7/2007 ---------------- Notes:- 1. Substituted vide Not. 56/2014 - Dated 6-8-2014